OBJECTIVES: To evaluate healthcare costs and medication use patterns (persistence, discontinuation and switching) in patients with rheumatoid arthritis (RA) on etanercept (ETN), infliximab (IFX) or adalimumab (ADA) in Texas Medicaid. METHODS: Prescription and medical claims for Texas Medicaid beneficiaries (18-63 years) with an RA diagnosis (ICD-9-CM code 714.0x) without claims for a biologic agent in the 6-months pre-index (July 1, 2003 to December 31, 2010) were analyzed over an 18-month study period between July 1, 2003 and August 31, 2011 (6-month pre- and 12-month post-index) based on their index biologic (ADA, ETN, or INF). The primary outcomes were 1-year persistence, discontinuation, switching and healthcare costs (RA-related and TNF inhibitor costs) to Texas Medicaid post-index, adjusted to 2011 US dollars using the medical consumer price index. Cohorts were constructed using propensity score (PS) matching controlling for baseline differences in demographics and clinical characteristics. RESULTS: After PS matching, 822 patients (n=274/biologic group) comprised the final sample. The mean age (±SD) was 48.9 (±9.8) years, and the majority (69.2%) were between age 45 and 63, Hispanic (53.7%) and female (88.0%). Post-index mean (±SD) total healthcare costs were $16,477 (±$9,228), RA-related costs were $13,713 (±$8,309) and TNF inhibitor costs were $12,195 (±$8,517). For each cost variable (total healthcare, RA-related and TNF inhibitor costs), costs incurred by patients on ETN were significantly lower (p<0.01) than those incurred by ADA patients but significantly higher (p<0.01) than those incurred by IFX patients. Persistence to index TNF inhibitor therapy and likelihood to switch or discontinue were comparable among groups. Duration of medication use (i.e. persistence) prior to switching or discontinuation of index therapy was also comparable among groups. CONCLUSIONS: The data suggest comparable medication use patterns but significantly different healthcare utilization costs among Texas Medicaid RA patients on ETN, IFX or ADA.