Black and Hispanic Patients With Autoimmune Disorders Less Likely To Be Prescribed Specialty Drugs, Study Finds

Research underscores concerns that cost-sharing policies may contribute healthcare disparities that follow racial and ethnic lines.

Black and Hispanic patients with autoimmune disorders were less likely to have a prescription for a specialty biologic medication than white patients in all but the highest income levels, according to research results recently reported in the Journal of Managed Care Pharmacy.

Bruce Sherman, M.D.

Lead author Bruce W. Sherman, M.D., of the Case Western Reserve University School of Medicine, had previously reported research results showing that a smaller proportion of low-wage workers with autoimmune diseases had prescriptions for specialty drugs. This research adds race and ethnicity to that analysis and showed that among workers earning the same wagers, smaller proportions of Black and Hispanic patients were prescribed specialty biologic medication than white patients earning the same income, The exception was in the highest income group, which included those earning more than $106,000 year.

Specialty biologics such as Humira (adalimumab), Enbrel (etanercept) and Stelara (ustekinumab) have transformed the management of autoimmune diseases such as rheumatoid arthritis, Crohn’s disease and psoriasis. But their high prices have made the coverage of drugs increasingly expensive, which has, in turn, lead to coverage policies designed to curb those expenditures.

“Employer efforts to manage SpRx [specialty drug] costs by implanting increased cost sharing from enrollees have contributed to disparities in the use of these medications with a lower prevalence of SpRx use among low-wage earners with autoimmune conditions,” Sherman and his colleagues wrote in the introduction of their study.

Sherman and his colleagues said that to the best of their knowledge, this was the first study using a national database that included an intersectional analysis of both race and income. The database that Sherman and his colleagues used is the IBM Watson Health MarketScan Database, which includes outpatient, inpatient and pharmaceutical claim data on between 40 million and 50 million people insured by 150 self-insured employers.

The race and ethnicity differences that the research identified were greatest in the lower income ranges. For example, among employees earning $35,000 or less, 4.5% of Hispanic patients with an autoimmune disease had at least one filled prescription for a specialty medication compared with 9.4% of White patients. At 4.5%, the proportion of Black patients with one filled prescription was similar to Hispanic patients.

In the $35,5001-$47,000 wage category, 5.5% of Black patients and 6.1% of Hispanic patients had at least one prescription compared with 10.6% of white patients.

The differences were narrower in the $47,001-$71,000 and $71,001-$106,000 wage categories. In the highest wage category of $106,001 and above, 11.9% of Black patients had at least one specialty pharmacy prescription filled compared with 11% of Hispanic patients and 12.7% of White patients.

Sherman and his colleagues started with data on more than 2 million active employees. But race and ethnicity information were available for only about one-third (617,117) of them. In that group, they identified 47,839 people with an autoimmune disorder and of those, 5,358 had at least one claim for a specialty medication. The prescriptions of special medications they looked for included Cimzia (certolizumab pegol), Cosentyx, Dupixent (dupilumab), Enbrel , Humira, Stelara and others.