Express Scripts’ study results regarding the impact of specialty pharmacy on treatment costs for rheumatoid arthritis (RA) were recently published in the American Journal of Pharmacy Benefits.
In order to evaluate the impact of specialty pharmacy management on medication adherence, medical utilization and medical costs for patients with RA, researchers compared outcomes for RA patients who filled their prescriptions at specialty pharmacies as opposed to retail pharmacies.
They used de-identified data over a three year period from administrative claims for patients with prescriptions for etanercept or adalimumab. Primary outcome measures consisted of RA medication adherence; occurrence of office visits, hospitalization, or emergency department visits; drug costs; and medical costs.
Medication adherence was measured using a medication possession ratio (MPR), which was defined as the proportion of days covered by medication supply during one year. Medical resource utilization was measures included the percentage of patients with one or more office visits, the percentage of patients who were hospitalized, the percentage of patients who had emergency department visits, and the number of office visits per patient within the year. Cost outcomes consisted of RA prescription drug costs, total prescription drug costs, and total medical costs per year. The top one percent of cases was excluded from the sample to keep the impact of medical cost outliers minimal.
They found substantial higher levels of medication adherence for RA patients who filled their prescriptions through a specialty pharmacy compared to a retail pharmacy: In 2006 results showed 62.6 percent versus 49.8 percent, in 2007 results showed 67.9 percent versus 50.6 percent, and in 2008 results showed 60.5 percent versus 44 percent.
According to the report, in 2007 and 2008 patients using specialty pharmacies were significantly less likely to have an office visit as well as a lower percentage of hospitalizations, however not enough to be statistically significant. In 2008 emergency department visits for specialty patients was substantially lower.
They found that prescription drug costs were much higher for specialty patients than retail in all three years, and adjusted costs for RA medications averaged $2733 higher in 2006, $3676 higher in 2007, and $3912 in 2008. Adjusted costs for all medications averaged $3107 higher for specialty in 2006, $4049 higher in 2007, and $4059 higher in 2008. On the other hand, average medical costs were significantly lower for patients using specialty pharmacies as opposed to retail. They averaged $1099 lower in 2006, $2137 lower in 2007, and $1324 lower in 2008.
The authors concluded that, “Specialty pharmacy management can increase adherence to RA medication therapy, reduce medical resource use, and reduce medical costs. Savings in indirect costs may help offset the increased drug costs associated with better adherence.”
Source: The American Journal of Pharmacy Benefits