Patients More Likely to Start Specialty Medications When Out-of-Pocket Costs Are Under $250


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

Increasing member out-of-pocket costs is a common strategy for controlling escalating costs of specialty drugs. These drugs are used to treat complex and chronic conditions and can cost tens of thousands of dollars or more per year. For this study, Prime researchers reviewed claims from members and identified people newly starting therapy with a biologic anti-inflammatory (BAI) drug--such as those used to treat rheumatoid arthritis--or people starting treatment for multiple sclerosis (MS).

The analysis of members attempting to newly start their MS or BAI therapy found 10.5 percent and 9.8 percent, respectively, had an OOP greater than $1,000 for their first prescription.  Conversely, about two thirds of members starting these treatments had an OOP less than $100.

As costs rise, the study found members are more likely to abandon their new prescription. Abandonment rates became significantly higher for both MS and BAI drugs when OOP reached $250. Additionally, when OOP reached $2,000 or more, the number of members abandoning their new MS prescription was nearly 24 times higher compared to members with OOP less than $100. Similarly, the number abandoning a BAI prescription was more than 19 times higher.

"This analysis indicates costs may be impacting members' ability to initiate these important treatments," said Pat Gleason, PharmD, BCPS, FCCP, director of health outcomes for Prime. "Health insurers should consider these findings when designing pharmacy benefits and keep in mind the members' maximum OOP cost per claim for preferred formulary specialty drugs."

The study reviewed more than 11 million commercial claims, identifying 3,293 members with an MS claim and 12,644 with a BAI claim, between July 1, 2010 and December 31, 2012.

Source: Prime Therapeutics LLC,