How Does Specialty Drug Use Vary Among Employer-Sponsored Health Plans?

A recent study aimed to investigate the relationship between race, ethnicity, wage status, and the utilization of specialty medications (SpRx) among employees with autoimmune conditions (AICs) enrolled in employer-sponsored health insurance. The research was conducted in 2018 using retrospective data from the IBM Watson MarketScan database, focusing on full-time, benefits-enrolled employees.

Demographic factors such as race, ethnicity, and wage level were explored to understand their impact on SpRx use and adherence patterns. Employees were divided into subgroups based on their race and ethnicity as per employer-provided data. Wage data was used to classify employees into annual income quartiles, with the lowest quartile further subdivided into two groups for closer examination.

The study analyzed the following outcomes: the number of days' supply of SpRx for AICs per month, the proportion of days covered (PDC), and medication discontinuation rates. Generalized linear regression was employed to assess differences while adjusting for various patient and other characteristics.

The study included over 2 million enrollees, and race and ethnicity data were available for 617,117 (29.8%) of them. Among these, 47,839 (7.8%) were identified as having an autoimmune condition of interest, with varying prevalence rates of AICs across different race and wage categories.

The results revealed significant disparities in SpRx utilization by race and ethnicity, with Black and Hispanic populations experiencing lower SpRx utilization rates compared to White individuals across different wage categories. The highest wage category was an exception, where the differences in SpRx utilization were not significant.

Specifically, Black enrollees had notably lower SpRx-AIC utilization rates than White enrollees in various wage groups, indicating disparities in access to these specialized medications. Similarly, Hispanic enrollees had lower SpRx-AIC utilization rates compared to White enrollees in specific wage categories.

However, when examining PDC and 90-day discontinuation rates, there were no significant differences observed among race and ethnicity groups within their respective wage bands. This suggests that once individuals initiated SpRx treatment, their adherence and medication discontinuation rates were relatively consistent regardless of their racial or ethnic background.

In conclusion, this study highlights the existence of racial, ethnic, and wage-related disparities in the use of specialty medications for autoimmune conditions among employees with employer-sponsored insurance. The findings underscore the likelihood that these disparities contribute to inequities in healthcare outcomes for non-White and low-income populations with such insurance coverage. These insights call for a closer examination of healthcare access and equity for these marginalized groups to ensure more equitable health outcomes.

The study was sponsored by the National Pharmaceutical Council, emphasizing the importance of addressing these disparities in access to specialty medications and promoting health equity among diverse employee populations.