This reads like an advertisement for Orencia.
Biologics like Enbrel, Humira, and Remicade all act on slightly different parts of the TNFalpha pathway. Some patients respond to one and not the others. Also, biologics can become less effective over time, so many patients will switch from Enbrel to Humira after a few years.
Orencia is not a TNFalpha inhibitor, but a T-cell signaling inhibitor.
Think of your immune system like a demolition crew. If something is in your house that doesn't belong, they walk into the room, smash it to bits with hammers, and then someone else comes along and sweeps up the debris.
There are also people walking around your house looking for shit that doesn't belong, like spotters. They have the blueprints, and if they find something that shouldn't be there, they call the demolition team.
Rheumatoid and Psoriatic arthritis are the result of an overactive immune system. The people with the blueprints will walk into a dusty room and think "This wall isn't supposed to be dusty!" and call the demolition crew. The crew shows up and busts down the wall, kicking up more dust. The spotters see more dusty walls and call more demo teams. More people in the room, more demo, more dust, the cycle continues.
Incidentally, this is also more or less what causes allergic reactions and flu symptoms, except for those you have the Mucus Crew which comes in and hoses everything down with mucus. Fly got in the house? Smash it with hammers and then cover everything in mucus.
Anyways, TNFalpha is sort of like the hammers. Biologics like Enbrel, Humira, and Remicade all act on the hammers, making it harder to swing them or making them less effective at destruction. T Cells are sort of like the people with the blueprints. T Cells use two receptors to recognize foreign material, so think a measuring tape and a level. Orencia comes along and knocks the level out of the spotter's hand, so they are less likely to call the demo team.
Neither treats the underlying cause, the overactive immune system, and both treatments leave the patient more vulnerable to infections and leukemia. It also takes months to determine if they have been effective, because you have to heal the damage before you can determine that there hasn't been additional damage.
All that is a long way of saying, no doctor can predict which treatment will be effective. No doctor could predict that, if Enbrel and Humira have not been or stopped being effective, that Remicade wouldn't work. No doctor could predict that Orencia would work where the others had failed.
Neither can the insurance companies, of course.
This article makes it sound like the patient was forced to try something they knew would be ineffective before they were allowed to try a treatment they knew would be effective. There are four problems with that statement.
Medical decisions should be made by doctors and patients. Medical insurance companies shouldn't exist at all, at least not in their current form. So I agree that there's a problem here, but we don't get anywhere by misrepresenting what we know and don't know.