OBJECTIVES: To examine the time to anti-tumor necrosis factor (anti-TNF) therapy initiation from rheumatoid arthritis (RA) diagnosis, utilizing a managed care database. METHODS: A retrospective study utilizing the PharMetrics managed care administrative claims database was conducted. The first anti-TNF (infliximab, etanercept, or adalimumab) encounter (index biologic date) among RA patients between January 1, 2001 and January 1, 2004 was identified. Patients were required to have a minimum of 12-months of continuous plan eligibility prior to and following their index anti-TNF date. The outcome of interest was the time to anti-TNF initiation, which was defined as the time between index diagnosis and index anti-TNF date. Three mutually exclusive cohorts were developed based on the date between their index diagnosis and index anti-TNF date including; <1 year, 1-2 years, and >2 years. Demographic, co-morbidity, and disease severity variables were assessed using descriptive statistics. RESULTS: A total of 2,231 patients met study inclusion criteria including 729 (32.7%) patients initiating therapy within less than one year of diagnosis; 966 (43.3%) initiating therapy within 1-2 years of diagnosis; and 536 (24.0%) initiating therapy greater than 2 years following diagnosis. Over two-thirds of the patients were females and the mean age was 50.1 years. The average time to initiating biologic therapy in the study population was 563.38 days from RA diagnosis. Although not statistically significant, patients who began biologics more than 2 years after diagnosis had higher rates of co-morbidities and greater disease severity. CONCLUSION: This study indicates that over 67% of the population initiated anti-TNF therapy greater than one year following RA diagnosis. The American College of Rheumatology guideline for the management of RA calls for its early diagnosis and treatment, as delayed therapy may lead to worse clinical outcomes, including functional loss. Thus, clinicians may need to treat RA earlier with anti-TNF therapy.