Race, Income Impact Specialty Drug Use of Autoimmune Condition Treatments | AMCP Nexus 2023

Race and wage-disparities can play a part in specialty drug use for autoimmune condition treatments and in the inequities of health outcomes among non-white and low-income populations with employer-sponsored insurance.

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In a platinum award 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,” authors expressed that spending on specialty medications for autoimmune conditions 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, both Rochelle Henderson, PhD, and Sharon Phares, PhD, of the National Pharmaceutical Council and Leah Kamin, MPH, of IBM Watson Health.

The increase in spending on specialty medications has led to greater patient cost-sharing through plan benefit design, including the use of consumer-directed health plans, higher deductible thresholds and copay accumulator adjustment programs.

Prior studies have shown different patterns of healthcare use associated with wage status, mainly driven by affordability issues, authors mentioned.

Out-of-pocket costs for autoimmune specialty medications have been shown to impact medication adherence, especially for those with low incomes.

In attempt to examine the association of race/ethnicity and wage status on specialty drug use and adherence among employees with autoimmune conditions enrolled in employer-sponsored health insurance, researchers observed data collected from the IBM Watson MarketScan database.

Data were 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 condition, including rheumatoid arthritis, atopic dermatitis, multiple sclerosis, psoriasis, Crohn's disease smf asthma.

Employees were also separated into income groups, and the lowest was further divided into two groups: equal to or less than $35,000, $35,001- $47,000, $47,001-$71,000, $71,001-$106,000, and ≥$106,001.

Outcomes included monthly days' supply of specialty medication for autoimmune conditions, 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 under employer-sponsored insurance, 47,839 were identified as having an autoimmune condition of interest. About 11% of those employees filled at least one specialty drug-autoimmune prescription.

It was found that the prevalence of specialty drug use was significantly lower among Black and Hispanic groups, across all wage categories except the highest wage category.

Additional data found that proportion of days covered, and 90-day discontinuation rates didn’t make a difference among race/ethnicity groups within the wage groups.

Authors suggest that the cause of lower specialty drug use is likely caused by affordability issues, access, medical mistrust and bias among contributors.

It was also noted that managed care pharmacy practitioners are positioned to identify and take steps to reduce observed disparities in specialty medication use for the treatment of autoimmune conditions.

Henderson mentioned that those within the managed care pharmacy space should keep these results in mind when thinking about their pharmacy benefit design.

“As (decision-makers are) thinking about the designing benefits, think about this: One size doesn't fit all,” Henderson said. “Think about income as well as race and ethnicity when they're designing benefits, when they're thinking about out of pocket, when they're thinking about utilization management. Consider the variation here and ‘how do we design those things that will result in greater access and greater use of these medications?’”