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The Costs of Ankylosing Spondylitis

Medically Reviewed by Michael W. Smith, MD on November 24, 2020

When you have ankylosing spondylitis (AS), you’re focused on taking care of yourself and avoiding flare-ups. As you manage the condition, the last thing you need is for medical expenses to take you by surprise too.

Ankylosing spondylitis, also called Bechterew’s disease, is a type of arthritis that affects around 300,000 Americans. Over time, it can make some of your vertebrae fuse, stealing your flexibility and making you hunch forward. It also can lead to pain or discomfort in your ribs or hip and shoulder joints, and trigger uncomfortable inflammation in your eyes.

There is no cure for AS, but medication and physical therapy may lessen your symptoms and perhaps slow down the disease. Surgery isn’t often needed, unless you have severe joint damage.

When your AS flares up, your health care costs climb. A study published in 2018 tallied median AS-specific health care costs at $10,250 per year, driven largely by high outpatient visit and drug bills.

While most health insurance plans cover doctor’s visits, prescription medications, and physical therapy for AS, your deductibles and copays, or co-insurance premiums can add up over time. Research and early action position you to manage those costs more effectively.

Regular Office Visits

You can expect to visit a rheumatologist about once every 3 months or so to check on your condition and treatment plan. If AS is causing a lot of pain or discomfort, you’ll need additional appointments.

An average office visit for doctors such as rheumatologists cost $365, according to the most recent report from the U.S. Agency for Healthcare Research and Quality. For just over half of those visits, there were no out-of-pocket costs after insurance. For the others, the average patient bill was $94 per visit.

Medication

A rheumatologist will probably start you out on an over-the-counter, nonprescription pain medication for lower levels of AS inflammation. Examples of these nonsteroidal anti-inflammatory drugs (NSAIDs) include ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and indomethacin (Indocin, Tivorbex).

You later may need higher dosages of these NSAIDs to get relief from an AS flare-up. Since a bottle of 30 800-mg tablets of generic ibuprofen, for example, is advertised online for $14.99, NSAIDs purchases shouldn’t strain your budget too badly.

After some time, your rheumatologist either may decide NSAIDs aren’t enough to control your AS symptoms or their side effects are concerning. At that point, your doctor may prescribe:

Once you are taking prescription drugs, you will need to anticipate and manage wide price variations. For example, you can find prednisone advertised online for $12 to $21 per prescription; a 30% copay would make your cost as little as $3.60. But list prices for TNF blockers range from $740 per recommended dose of adalimumab to $2,315 for certolizumab pegol. The 30% copays would range from $222 to $695. While consumers rarely pay the list price, the out-of-pocket cost would still be substantial.

Tips: Comparing prices among local pharmacies and online is always a smart idea. You also can investigate medication assistance programs offered by many pharmaceutical companies. And, the Spondylitis Association of America has created an online list of resources to consult about financial assistance with both medical and prescription costs.

Physical Therapy Sessions

Physical therapy will be a key part of your AS treatment. A good therapist can provide pain relief to an AS patient and improve strength and flexibility, as well as recommend range-of-motion and stretching exercises to do on your own.

Tip: Check your insurance plan’s coverage of physical therapy before you schedule the first session. Most insurance plans do cover physical therapy (at 50% to 75%) by a licensed therapist if that appointment is expected to deliver an “essential benefit.” But you might need to meet the annual deductible first. Also, some plans cap total therapy costs or the total number of sessions, and some states require a primary care doctor’s referral.

Depending on the level of service given, copays can reach as high as $75 per physical therapy session. In one study, an AS patient had 28 sessions over 1 ¾ years, meaning that family hypothetically needed $2,100 out of pocket.

Don’t Wait, Act Now

Ankylosing spondylitis is a physically and emotionally taxing disease, and it can be financially taxing too. But if you are proactive about researching potential costs and aggressive about working with doctors, insurers, and drug companies, then you can make AS more affordable for your family.

WebMD Medical Reference

Sources

Sources:

University of Washington: “Ankylosing spondylitis.”

Spondylitis Association of America: “Overview of Ankylosing Spondylitis.”

Mayo Clinic: “Ankylosing spondylitis.”

Arthritis Foundation: “Taming High Disease Activity in Early Ankylosing Spondylitis.”

National Institute of Arthritis and Musculoskeletal and Skin Diseases: “Ankylosing Spondylitis.”

Rheumatology and Therapy: “Healthcare Utilization and Direct Costs in Patients with Ankylosing Spondylitis Using a Large US Administrative Claims Database.”

CreakyJoints digital community: “Seeing a Rheumatologist for Ankylosing Spondylitis: What to Know Before Your First Visit.”

U.S. Agency for Healthcare Research and Quality: “Statistical Brief #517: Expenses for Office-Based Physician Visits by Specialty and Insurance Type, 2016.”

Immunex Corp.: “Paying for ENBREL.”

Academy of Neurologic Physical Therapy: “Health Insurance Coverage.”

North Carolina Medical Journal: Insurance Coverage, Costs, and Barriers to Care for Outpatient Musculoskeletal Therapy and Rehabilitative Services.”

Journal of Physical Therapy Science: “Optimizing physical therapy for ankylosing spondylitis: a case study in a young football player.”

Academy of Neurologic Physical Therapy: “Insurance Coverage.”

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