Premium
Specialty Tier‐Level Cost Sharing and Biologic Agent Use in the Medicare Part D Initial Coverage Period Among Beneficiaries With Rheumatoid Arthritis
Author(s) -
Doshi Jalpa A.,
Hu Tianyan,
Li Pengxiang,
Pettit Amy R.,
Yu Xinyan,
Blum Marissa
Publication year - 2016
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.22880
Subject(s) - medicine , cost sharing , rheumatoid arthritis , specialty , odds ratio , confidence interval , medicare part d , family medicine , physical therapy , nursing , medical prescription , prescription drug
Objective To examine associations between specialty tier‐level cost sharing and use of biologic agents for rheumatoid arthritis (RA) during Medicare Part D's initial coverage period (ICP). Methods This was a retrospective study using 2007–2010 5% sample Medicare files to examine RA patients with use of a Part D RA biologic agent in the prior year. Patients without low‐income subsidies (non‐LIS group), who faced specialty tier‐level cost sharing, were compared to a control group of low‐income subsidy patients (LIS group), who faced nominal out‐of‐pocket costs in the ICP. Outcomes included use of a Part D or Part B RA biologic agent during the ICP and presence of a ≥30‐day continuous gap in treatment among Part D biologic agent users in the ICP. Risk‐adjusted outcomes were estimated using logistic regressions, controlling for patient demographic, clinical, and Part D plan characteristics. Results On average, a 30‐day Part D biologic agent supply cost the non‐LIS group $484 out of pocket (29.9% cost sharing) versus $5 (0.3% cost sharing) for the LIS group. The non‐LIS group was less likely to fill Part D biologic agents (61.2% versus 72.7%, odds ratio [OR] 0.58 [95% confidence interval (95% CI) 0.46–0.72]; P < 0.001), more than twice as likely to receive Part B biologic agents (9.9% versus 4.4%, OR 2.41 [95% CI 1.61–3.60]; P < 0.001), and less likely to use any biologic agent (70.1% versus 76.9%, OR 0.69 [95% CI 0.55–0.88]; P = 0.002). The non‐LIS subgroup filling Part D biologic agents had approximately twice the odds of a gap in both Part D biologic agent and any biologic agent availability. Conclusion Specialty tier‐level cost sharing was associated with interruptions in RA biologic agent treatment among Medicare patients.