Study Ties Specialty Drug Use to Annual Care Costs


An assessment of costs and specialty drug use within 4 chronic conditions found specialty drugs contribute to overall costs for insurance plan members.

An assessment of costs and specialty drug use within 4 chronic conditions found specialty drugs contribute to overall costs for insurance plan members.

Specialty drug use produces the majority of annual total direct cost of care expenditures, although use of specialty therapy varied between 4 chronic conditions analyzed, according to the results of a study appearing in the September 2013 edition of Journal of Managed Care Pharmacy.

The authors evaluated specialty drug use and costs for inflammatory bowel disease (IBD), psoriasis, rheumatoid arthritis, and multiple sclerosis (MS), and defined specialty drugs as having a total paid of $1000 or more per month.

They then assessed total health care costs for each condition in terms of average cost for each patient per year (determined by adding the costs for all members with the condition and then dividing by the number of members with the condition) and the average cost for the health plan’s enrollment (determined by adding the costs of all members with the condition and dividing by the entire health plan enrollment).

The researchers also calculated the trends of specialty drug use among patients, per person total cost, and cost for each condition based on a 3-year period. Their analysis showed an increased proportion of specialty drug spending for MS, psoriasis, and IBD therapies, whereas the proportion of total health care spending on rheumatoid arthritis specialty drugs remained relatively stable.

An analysis of data from 2010 showed the rates of specialty drug use varying within each condition, with the authors detecting the lowest rate of specialty drug use within the patients with IBD (13.7%) and the highest rate for patients with MS (71.8%). The data also showed the average per-patient, per-year health care cost for the conditions researched was lowest for patients with psoriasis—an average of $14,815—and highest for patients with MS—an average of $36,901. An assessment of the per-person, per-year cost for specialty drugs revealed the highest drug cost for patients with MS, at $28,152, and lowest for patients with rheumatoid arthritis, at $18,098. Patients with IBD and psoriasis paid $21,438 and $19,612, respectively.

When calculated within the terms of an entire benefit plan’s enrollment, the total costs were highest for patients with rheumatoid arthritis ($103.82) and lowest for patients with psoriasis ($52.62). The cost of specialty drugs when calculated in terms of an entire benefit plan’s enrollment showed costs of $34.74 for patients with MS, $28.74 for rheumatoid arthritis, $16.91 for psoriasis, and $13.09 for IBD.

Within each cohort of specialty drug patients, the annual cost of specialty therapy comprised half of the total annual direct cost of care, the authors noted.

“The importance of the chronic conditions studied is exemplified in the finding that fewer than 1.5% of enrollees in the health plan we examined had 1 of the 4 conditions of interest, but they accounted for 7.2% of the entire plan membership health care expenditures,” the authors wrote.

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