Racial and wage disparities may play a role in the use of specialty drugs for the treatment of autoimmune diseases and in health inequities among non-white and low-income populations with state-sponsored insurance. employer.
In a platinum-winning poster presented at the AMCP Nexus 2023 conference in Orlando, “Specialty Drug Use Varies by Race and Wage Among Employees with Employer-Sponsored Health Insurance,” the authors said that Spending on specialty drugs for autoimmune diseases has increased in recent years. , raising affordability concerns for employers.
Authors of the National Pharmaceutical Council study included Bruce Sherman, MD, of Case Western Reserve University, Rochelle Henderson, PhD, and Sharon Phares, PhD, of the National Pharmaceutical Council, and Leah Kamin, MPH, of IBM Watson Health.
Increased spending on specialty drugs has led to greater cost sharing for patients through plan benefit designs, including the use of consumer-directed health plans, higher deductible thresholds, and copay accumulator adjustment programs.
Previous studies have shown different health care utilization patterns associated with salary status, primarily driven by affordability concerns, the authors mentioned.
The direct costs of specialty autoimmune medications have been shown to impact medication adherence, particularly for low-income individuals.
To examine the association of race/ethnicity and salary status on specialty medication use and adherence among employees with autoimmune diseases enrolled in employer-sponsored health insurance, the Researchers observed data collected from the IBM Watson MarketScan database.
Data was collected from 2,071,980 active employees with employer-sponsored health insurance in 2018.
However, the study population was limited to those taking a specialty medication for at least one applicable autoimmune disease, including rheumatoid arthritis, atopic dermatitis, multiple sclerosis, psoriasis, Crohn’s disease, and asthma.
Employees were also divided into income groups, and the lowest were divided into two groups: equal to or less than $35,000, $35,001 to $47,000, $47,001 to $71,000, $71,001 to $106,000 and ≥ $106,001.
Outcomes included monthly days supply of specialty medications for autoimmune diseases, medication discontinuation rates, and proportion of days covered.
Generalized linear regressions were also used to assess differences while adjusting for patient characteristics.
Of the more than 2 million active employees with employer-sponsored insurance, 47,839 have been identified as having an autoimmune disease of interest. Approximately 11% of these employees filled at least one prescription for specialty autoimmune medications.
The prevalence of specialty drug use was found to be significantly lower among black and Hispanic groups, in all salary categories except the highest salary category.
Additional data revealed that proportion of days covered and dropout rates after 90 days did not differ between race/ethnicity groups within salary groups.
The authors suggest that the cause of low uptake of specialty medications is likely due to issues of affordability, access, medical distrust, and bias among contributors.
It was also noted that managed care pharmacy practitioners are able to identify and take action to reduce disparities observed in the use of specialty medications for the treatment of autoimmune diseases.
Henderson mentioned that those working in managed care pharmacies should keep these findings in mind when thinking about designing their pharmacy benefits.
“As (policymakers) consider the benefits of design, consider this: There is no one-size-fits-all solution,” Henderson said. “Think about income and race and ethnicity when they’re designing benefits, when they’re thinking about out-of-pocket expenses, when they’re thinking about utilization management. Consider the variation here and “how can we design these things that will lead to greater access and greater use of these medications?” »
This article was originally published in Managed Healthcare Executive.
