OBJECTIVES: To analyze cost savings for the first year of a rheumatoid arthritis (RA) pathway program. Cardinal Health collaborated with CareFirst BlueCross BlueShield to develop the first payer-sponsored RA pathway program in the United States. Private-practice rheumatologist participation was voluntary, but reimbursement enhancements were offered to mitigate cost of pathway adoption and compliance. A steering committee comprised of 12 participating physicians created the pathway, which included an obligatory use of a real-time decision support and data capture tool; use of disease-modifying antirheumatic drugs (DMARDs) as first-line treatment for at least 12 weeks prior to use of biologic agents; and a requirement that dose, schedule, and adjustments for biologic agents follow package label prescribing guidelines. METHODS: RESULTS: DMARD use increased by 7.4% over the first year contributing to a lower cost of care annualized at $1,069,790. Control of biologic “dose-creep” contributed $80,230 to further lowering cost annually. Average hospital facility costs per biologic infusion were near double that of community practice ($5000 vs $2500, respectively). Participating providers had 80% fewer facility infusions than nonparticipating providers (11% vs 55%, respectively). CONCLUSIONS: RA pathway algorithm-compliant prescribing behavior for DMARDs and biologics resulted in dramatic savings. Preserving community site of care represents a significant savings potential for RA management.