METHODS:  A retrospective cohort of medication transaction data (IMS Brogan Lifelink® database) from Ontario and Quebec pharmacies was analysed. Patients were eligible if their last etanercept transaction from a private plan (index date) was between 01/01/2010 and 06/30/2013 and their first transaction from a public plan was within one year from the index date. The gaps in reimbursement were the difference between the index date plus days’ supply and the date of the first public etanercept transaction. RESULTS:  Of 474 patients included, 432 continued a DMARD or biologic in their public plan and 397 had at least 1 year of follow-up from their first public claim. Patients were 50% from Ontario, 40% male. 73% had rheumatoid arthritis (RA) and 70% were < 65 years. 75% had a gap in reimbursement (median = 19 days). 25% had either no gap, or an overlap in dispensed prescriptions, while 9% stopped their therapy altogether. Of patients who continued etanercept therapy on a public plan, 45% had a gap in coverage that would be considered a clinically meaningful delay in treatment (>21 days). For etanercept patients who continued therapy for at least 1 year, 71% progressed to etanercept ± DMARD, 5% to another biologic ± DMARD, and 23% to a DMARD only as their first line public therapy. CONCLUSIONS: A clinically significant number of patients experienced a meaningful gap in etanercept coverage which can result in suboptimal clinical outcomes. Over 20% of patients revert back to DMARD therapy on a public plan even after previously receiving a biologic. Almost 10% do not continue RA treatment on a public plan.