Cost Sharing, Family Health Care Burden, and the Use of Specialty Drugs for Rheumatoid Arthritis

Objectives. To examine the impact of benefit generosity and household health care financial burden on the demand for specialty drugs in the treatment of rheumatoid arthritis (RA). Data Sources/Study Setting. Enrollment, claims, and benefit design information for 35 large private employers during 200...

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Bibliographic Details
Published in:Health services research 2010-10, Vol.45 (5p1), p.1227-1250
Main Authors: Karaca-Mandic, Pinar, Joyce, Geoffrey F., Goldman, Dana P., Laouri, Marianne
Format: Article
Language:English
Subjects:
Adalimumab
Aged
Analysis
Antibodies, Monoclonal - economics
Antibodies, Monoclonal, Humanized
Antirheumatic Agents - economics
Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - drug therapy
Burden
Care and treatment
Cost of Illness
Cost sharing
Cost Sharing - economics
Drug Costs - statistics & numerical data
Drug therapy
Drug Utilization - economics
Drugs
Etanercept
Female
Financing, Personal - economics
Generosity
Health Benefit Plans, Employee - economics
Health care costs
Health care expenditures
Health costs
Health insurance
Health Services Research
household burden
Households
Humans
Immunoglobulin G - economics
Immunologic Factors - economics
Immunologic Factors - therapeutic use
Immunotherapy
Infliximab
Initiation
Insurance Claim Reporting - statistics & numerical data
Insurance Coverage - economics
Male
Medical care, Cost of
Medicare
Medicare Part D - economics
Middle Aged
Multivariate Analysis
Out of pocket costs
pharmacy benefit design
Receptors, Tumor Necrosis Factor
Rheumatoid arthritis
Specialty drugs
Specialty products
Studies
Supply and demand
Time use
United States
Utilization and Costs
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Summary:Objectives. To examine the impact of benefit generosity and household health care financial burden on the demand for specialty drugs in the treatment of rheumatoid arthritis (RA). Data Sources/Study Setting. Enrollment, claims, and benefit design information for 35 large private employers during 2000–2005. Study Design. We estimated multivariate models of the effects of benefit generosity and household financial burden on initiation and continuation of biologic therapies. Data Extraction Methods. We defined initiation of biologic therapy as first‐time use of etanercept, adalimumab, or infliximab, and we constructed an index of plan generosity based on coverage of biologic therapies in each plan. We estimated the household's burden by summing up the annual out‐of‐pocket (OOP) expenses of other family members. Principal Findings. Benefit generosity affected both the likelihood of initiating a biologic and continuing drug therapy, although the effects were stronger for initiation. Initiation of a biologic was lower in households where other family members incurred high OOP expenses. Conclusions. The use of biologic therapy for RA is sensitive to benefit generosity and household financial burden. The increasing use of coinsurance rates for specialty drugs (as under Medicare Part D) raises concern about adverse health consequences.
ISSN:0017-9124
1475-6773
DOI:10.1111/j.1475-6773.2010.01117.x