Health Plan Utilization and Costs of Specialty Drugs Within 4 Chronic Conditions
Health Plan Utilization and Costs of Specialty Drugs Within 4 Chronic Conditions
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DOI：
10.18553/jmcp.2013.19.7.542
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发表时间：
2013-09-01
影响因子：
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通讯作者：
Shah, Nilay D.
中科院分区：
文献类型：
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作者：
Gleason, Patrick P.;Alexander, G. Caleb;Shah, Nilay D.
背景技术背景：药物通常被定义为专业，因为它们很昂贵;然而，用于定义药物为专业的其他标准包括生物药物，需要注射或输注药物，需要特殊处理或药物只能通过有限的分销网络获得。特种药物在治疗慢性疾病如多发性硬化症（MS）、类风湿性关节炎（RA）、银屑病和炎症性肠病（IBD）方面发挥着越来越重要的作用，但对这些疾病的综合医疗和药学效益利用和成本趋势知之甚少。目的：描述MS、RA、银屑病和IBD的患病率、专科药物治疗、专科费用、非专科费用以及医疗和药房福利范围内的护理总直接费用的趋势。这是对由100万会员组成的商业保险人群的描述性分析，使用了2008年至2010年的综合医疗和药房行政索赔数据。分析仅限于连续入组的65岁以下商业保险个人。使用标准化标准定义MS、RA、银屑病和IBD的条件特异性队列。分析了疾病患病率、疾病的专科药物使用和直接护理总成本的趋势。直接成本细分为：医疗福利专业药物成本、医疗福利所有其他成本、药房福利专业药物成本和药房福利所有其他成本。从2008年到2010年，计算了护理总成本和子类别成本的趋势和复合年增长率。结果：疾病患病率从MS的1,720/百万成员到RA的4,489/百万成员不等。银屑病和MS疾病的患病率在3年内没有变化;但是，IBD患病率增加了7.0%，RA患病率增加了9.7%。IBD的专科药物使用率最低（13.7%），MS的专科药物使用率最高（71.8%）。最低的年度总护理费用是牛皮癣（14，815美元），最高的年度总费用是MS（36，901美元）。每种疾病最常用的专科药物如下：格拉替雷（MS），依那西普（RA和银屑病）和英夫利昔单抗（IBD）。与所有银屑病成员相比，银屑病专科药物使用者的年度总费用增加了一倍以上（29，565美元对14，815美元）。使用特殊药物的MS成员的总成本仅略高（41，760美元对36，901美元）。在每个队列的专科药物使用者中，专科药物的年度费用占年度总费用的50%或更多。专科药物的年支出增长率范围为4.4%至18.0%.CONCLUSION：虽然专科药物的使用在所分析的4种慢性疾病中差异很大，但当使用专科药物时，它们占年度直接护理总成本的大部分。由于专科药物在慢性病护理总成本中所占的比例越来越大，医疗保险公司需要对专科药物的使用更加警惕，并专注于4个成本节约管理机会：药物分销渠道，利用管理，合同活动和护理协调。版权所有（c）2013年，管理护理药房学院。All rights reserved.
BACKGROUND: Drugs are most typically defined as specialty because they are expensive; however, other criteria used to define a drug as specialty include biologic drugs, the need to inject or infuse the drug, the requirement for special handling, or drug availability only via a limited distribution network. Specialty drugs play an increasingly important role in the treatment of chronic conditions such as multiple sclerosis (MS), rheumatoid arthritis (RA), psoriasis, and inflammatory bowel disease (IBD), yet little is known regarding the comprehensive medical and pharmacy benefit utilization and cost trends for these conditions.OBJECTIVE: To describe MS, RA, psoriasis, and IBD trends for condition prevalence, treatment with specialty drugs, specialty costs, nonspecialty costs, and total direct costs of care within the medical and pharmacy benefits.METHODS: This was a descriptive analysis of a commercially insured population made up of 1 million members, using integrated medical and pharmacy administrative claims data from 2008 to 2010. Analyses were limited to continuously enrolled commercially insured individuals less than 65 years of age. Condition-specific cohorts for MS, RA, psoriasis, and IBD were defined using standardized criteria. Trends in condition prevalence, specialty drug use for the conditions, and direct total cost of care were analyzed. The direct costs were subcategorized into the following: medical benefit specialty drug costs, medical benefit all other costs, pharmacy benefit specialty drug costs, and pharmacy benefit all other costs. Trends and compound annual growth rates were calculated for the total cost of care and subcategory costs from 2008 through 2010.RESULTS: Condition prevalence ranged from a low of 1,720 per million members for MS to a high of 4,489 per million members for RA. Psoriasis and MS condition prevalence rates were unchanged over the 3 years; however, IBD prevalence increased 7.0%, and RA prevalence increased 9.7%. The rate of specialty drug use was lowest for IBD (13.7%) and highest for MS (71.8%). The lowest total annual cost of care was for psoriasis ($14,815), and the highest total annual cost was for MS ($36,901). The most commonly used specialty drugs for each of the conditions were as follows: glatiramer (MS), etanercept (RA and psoriasis), and infliximab (IBD). The total annual costs were more than double for the specialty drug users for psoriasis compared with all the psoriasis members ($29,565 vs. $14,815). The total costs were only somewhat higher among MS members using specialty drugs ($41,760 vs. $36,901). Among specialty drug users for each of the cohorts, the annual costs of specialty drugs accounted for 50% or more of the total annual costs. The annual spending growth rate for specialty drugs ranged from 4.4% to 18.0%.CONCLUSIONS: Although specialty drug utilization varied widely across the 4 chronic conditions analyzed, when specialty drugs were used they accounted for the majority of the annual total direct cost of care. Because specialty drugs are accounting for a growing portion of chronic disease total cost of care, health insurers will need to become more vigilant regarding specialty drug use and focus on 4 cost saving management opportunities: drug distribution channel, utilization management, contracting activities, and care coordination. Copyright (c) 2013, Academy of Managed Care Pharmacy. All rights reserved.