Objective: The primary purpose of this study was to evaluate the relationship between compliance to rheumatoid arthritis (RA) specialty medications and the total health care (pharmacy and medical) costs among RA patients. Methods: Deidentified pharmacy claims and medical claims data from a large pharmacy benefit manager's database were used in this retrospective study. Members who were primarily diagnosed with RA (ICD-9 714.0) and who have had at least one prescription for specialty medications between July-December 2005 were identified for the analysis. Specialty medications included for this study were as follows: Enbrel, Humira, Kineret, Remidace, Orencia, Rituxan. Members' pharmacy and medical claims in 2006 were collected to measure their compliance and total health care cost. Member's compliance to specialty medications was assessed by Medication Possession Ratio (MPR). Members were categorized into three different groups as – compliant (MPR >0.8), partially compliant (MPR 0.5-0.8), and non-compliant (MPR <0.5). All pharmacy costs; all medical costs and their breakdown cost such as physician visit, hospitalization, and ER visit etc; as well as total health care costs were computed and compared across the three groups using independent t-tests. Results: A total of 689 members were diagnosed as RA, but only 148 members using specialty RA medications were included for the analysis. Compliant group members had significantly high pharmacy cost ($19,615 vs. $10,050) and significantly low medical cost ($3041 vs. $9086 ) as compared to the non-compliant groups (P<0.01). Compliant group members showed significant low physician visit cost ($1,451 vs. $2,386 P<0.01) and hospitalization cost compared to non-compliant group ($236 vs. $3,206 P<0.05). The total health care costs were found to be comparable and non-significant among the three groups. Conclusion: The study demonstrated patients with good compliance tend to have higher pharmacy cost and lower medical costs as compared to those non-compliant to their therapy.