AMCP: Patients more likely to start specialty meds when costs stay under $250

April 4, 2014

When cost hits $2,000 or more, members abandon drugs at a much higher rate

Pharmacy plan members with specialty drug out-of-pocket costs less than $250 are more likely to start taking their medication than those with higher out-of-pocket costs. This finding is according to a new study presented by Prime Therapeutics (Prime) at the Academy of Managed Care Pharmacy (AMCP) 26th Annual Meeting & Expo in Tampa, Fla.

“Health insurers should consider these findings when designing pharmacy benefits and keep in mind the members’ maximum out-of-pocket cost per claim for preferred formulary specialty drugs,” said Pat Gleason, PharmD, BCPS, FCCP, director of health outcomes for Prime.

This analysis is an update of work published in the Journal of Managed Care Pharmacy. The previous analysis identified that commercially insured individuals attempting to initiate specialty drug multiple sclerosis (MS) or biologic anti-inflammatory (BAI) therapy were more likely to start the therapy if their out-of-pocket costs were less than $150.

The observational cross-sectional analysis used 11 Blue Cross and Blue Shield plans with 10.3 million commercially insured lives’ medical and pharmacy data from January 1, 2010, through June 30, 2013.

Separate analyses for MS and BAI therapy were performed to assess the association between member out-of-pocket expense and abandonment rate. The association of MS or BAI abandonment rate and out-of-pocket expense was tested with logistic regression models using zero to fifty dollars out-of-pocket as the reference group and adjusting for five factors such as age, as well as methotrexate use for the BAI analysis

“As out-of-pocket costs rise, the analysis found members are more likely to abandon their new prescription,” said Dr. Gleason. “Abandonment rates became significantly higher for both MS and BAI drugs when out-of-pocket reached $250.”

Higher abandonment

Additionally, when out-of-pocket costs reached $2,000 or more, the number of members abandoning their new MS prescription was nearly 24 times higher compared to members with out-of-pocket costs less than $100. Similarly, the number abandoning a BAI prescription was more than 19 times higher.

The majority of specialty drug categories have multiple therapeutic alternatives, according to Dr. Gleason. For example, MS and the BAIs drug classes each have more than seven FDA-approved specialty products.

“As health plans create preferred and non-preferred specialty benefit tiers, consideration should be given to maintain the preferred specialty tier out-of-pocket member cost share at a rate which encourages adherence,” she said.