College of Pharmacy, The University of Texas at Austin, Austin, Texas 78712-0127, USA.
Clin Ther. 2011 May;33(5):598-607. doi: 10.1016/j.clinthera.2011.04.021.
Specialty drugs are generally defined as high-cost injectable, infused, oral, or inhaled drugs that require close monitoring. Specialty drugs account for an increasing percentage of total drug expenditures, and management of specialty drugs has become a priority. A Central Texas-based integrated health maintenance organization system implemented a specialty drug benefit to manage expensive specialty drug costs.
Our objective was to measure and compare the change in adherence and persistence after implementation of copayment increases for select specialty medications used on a long-term basis (at least 2 years).
Patients who were long-term users of anti-inflammatory, immunosuppressant, cancer, and multiple sclerosis medications were selected. The intervention group consisted of those whose out-of-pocket payment for specialty medications increased, and the control group consisted of those whose out-of-pocket costs did not change. Adherence, defined by proportion of days covered, was measured every 3 months for 12 months before and after the change. Individual growth model analysis evaluated the changes in adherence. Cox regression analysis determined the difference in persistence between groups.
There were 178 and 202 patients in the intervention and control groups, respectively. The growth model showed a small but statistically significant decrease in proportion of days covered of 0.040 after copay changes in the intervention versus control group (P < 0.001) for immunosuppressants. The Cox regression analysis indicated a higher probability of intervention patients on anti-inflammatory drugs (hazard ratio [HR] = 2.53; 95% CI, 1.38-4.62) and immunosuppressants (HR = 3.01; 95% CI, 1.20-7.56) would be nonpersistent compared with those in their control groups.
The move to the specialty formulary allows for closer scrutiny of specialty utilization by pharmacists, who actively monitor utilization and access. Despite the minimal adherence decrease and significant persistence changes with certain drug types, the results indicated relatively more stability with specialty drug use than reported with traditional pharmaceuticals.
专科药物通常被定义为高成本的注射、输注、口服或吸入药物，需要密切监测。专科药物在总药物支出中所占比例不断增加，因此对专科药物的管理已成为当务之急。一家总部位于德克萨斯州中部的综合性医疗维护组织系统实施了专科药物福利，以管理昂贵的专科药物费用。
我们的目的是衡量和比较实施特定专科药物共付额增加后，长期（至少 2 年）使用的专科药物的依从性和持久性变化。
选择长期使用抗炎药、免疫抑制剂、癌症和多发性硬化症药物的患者。干预组由专科药物自付费用增加的患者组成，对照组由自付费用没有变化的患者组成。在调整前和调整后 12 个月内，每 3 个月测量一次以天为单位的覆盖率，以衡量依从性。个体增长模型分析评估了依从性的变化。Cox 回归分析确定了两组之间持久性的差异。
干预组和对照组分别有 178 名和 202 名患者。增长模型显示，在免疫抑制剂方面，与对照组相比，干预组自付额调整后以天为单位的覆盖率略有但具有统计学意义的下降（P < 0.001），为 0.040。Cox 回归分析表明，与对照组相比，抗炎药（危险比[HR] = 2.53；95%CI，1.38-4.62）和免疫抑制剂（HR = 3.01；95%CI，1.20-7.56）的干预组患者更有可能无法坚持治疗。
向专科药物处方集的转变使药剂师能够更密切地审查专科药物的利用情况，药剂师积极监测利用情况和获取情况。尽管某些药物类型的依从性略有下降，持久性变化显著，但结果表明，与传统药物相比，专科药物的使用相对更稳定。
