Cost sharing, family health care burden, and the use of specialty drugs for rheumatoid arthritis

Pinar Karaca-Mandic, Geoffrey F. Joyce, Dana P. Goldman, Marianne Laouri

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Objectives. To examine the impact of benefit generosity and household health care financial burden on the demand for specialty drugs in the treatment of rheumatoid arthritis (RA). Data Sources/Study Setting. Enrollment, claims, and benefit design information for 35 large private employers during 2000-2005. Study Design. We estimated multivariate models of the effects of benefit generosity and household financial burden on initiation and continuation of biologic therapies. Data Extraction Methods. We defined initiation of biologic therapy as first-time use of etanercept, adalimumab, or infliximab, and we constructed an index of plan generosity based on coverage of biologic therapies in each plan. We estimated the household's burden by summing up the annual out-of-pocket (OOP) expenses of other family members. Principal Findings. Benefit generosity affected both the likelihood of initiating a biologic and continuing drug therapy, although the effects were stronger for initiation. Initiation of a biologic was lower in households where other family members incurred high OOP expenses. Conclusions. The use of biologic therapy for RA is sensitive to benefit generosity and household financial burden. The increasing use of coinsurance rates for specialty drugs (as under Medicare Part D) raises concern about adverse health consequences.

Original languageEnglish (US)
Pages (from-to)1227-1250
Number of pages24
JournalHealth services research
Volume45
Issue number5 PART 1
DOIs
StatePublished - Oct 1 2010

Fingerprint

Cost Sharing
Family Health
Biological Therapy
Rheumatoid Arthritis
Delivery of Health Care
Pharmaceutical Preparations
Health Expenditures
Medicare Part D
Deductibles and Coinsurance
Information Storage and Retrieval
Drug Therapy
Health

Keywords

  • Specialty drugs
  • household burden
  • pharmacy benefit design

Cite this

Cost sharing, family health care burden, and the use of specialty drugs for rheumatoid arthritis. / Karaca-Mandic, Pinar; Joyce, Geoffrey F.; Goldman, Dana P.; Laouri, Marianne.

In: Health services research, Vol. 45, No. 5 PART 1, 01.10.2010, p. 1227-1250.

Research output: Contribution to journalArticle

Karaca-Mandic, Pinar ; Joyce, Geoffrey F. ; Goldman, Dana P. ; Laouri, Marianne. / Cost sharing, family health care burden, and the use of specialty drugs for rheumatoid arthritis. In: Health services research. 2010 ; Vol. 45, No. 5 PART 1. pp. 1227-1250.
@article{1a652de737f64396a29487677d113a09,
title = "Cost sharing, family health care burden, and the use of specialty drugs for rheumatoid arthritis",
abstract = "Objectives. To examine the impact of benefit generosity and household health care financial burden on the demand for specialty drugs in the treatment of rheumatoid arthritis (RA). Data Sources/Study Setting. Enrollment, claims, and benefit design information for 35 large private employers during 2000-2005. Study Design. We estimated multivariate models of the effects of benefit generosity and household financial burden on initiation and continuation of biologic therapies. Data Extraction Methods. We defined initiation of biologic therapy as first-time use of etanercept, adalimumab, or infliximab, and we constructed an index of plan generosity based on coverage of biologic therapies in each plan. We estimated the household's burden by summing up the annual out-of-pocket (OOP) expenses of other family members. Principal Findings. Benefit generosity affected both the likelihood of initiating a biologic and continuing drug therapy, although the effects were stronger for initiation. Initiation of a biologic was lower in households where other family members incurred high OOP expenses. Conclusions. The use of biologic therapy for RA is sensitive to benefit generosity and household financial burden. The increasing use of coinsurance rates for specialty drugs (as under Medicare Part D) raises concern about adverse health consequences.",
keywords = "Specialty drugs, household burden, pharmacy benefit design",
author = "Pinar Karaca-Mandic and Joyce, {Geoffrey F.} and Goldman, {Dana P.} and Marianne Laouri",
year = "2010",
month = "10",
day = "1",
doi = "10.1111/j.1475-6773.2010.01117.x",
language = "English (US)",
volume = "45",
pages = "1227--1250",
journal = "Health Services Research",
issn = "0017-9124",
publisher = "Wiley-Blackwell",
number = "5 PART 1",

}

TY - JOUR

T1 - Cost sharing, family health care burden, and the use of specialty drugs for rheumatoid arthritis

AU - Karaca-Mandic, Pinar

AU - Joyce, Geoffrey F.

AU - Goldman, Dana P.

AU - Laouri, Marianne

PY - 2010/10/1

Y1 - 2010/10/1

N2 - Objectives. To examine the impact of benefit generosity and household health care financial burden on the demand for specialty drugs in the treatment of rheumatoid arthritis (RA). Data Sources/Study Setting. Enrollment, claims, and benefit design information for 35 large private employers during 2000-2005. Study Design. We estimated multivariate models of the effects of benefit generosity and household financial burden on initiation and continuation of biologic therapies. Data Extraction Methods. We defined initiation of biologic therapy as first-time use of etanercept, adalimumab, or infliximab, and we constructed an index of plan generosity based on coverage of biologic therapies in each plan. We estimated the household's burden by summing up the annual out-of-pocket (OOP) expenses of other family members. Principal Findings. Benefit generosity affected both the likelihood of initiating a biologic and continuing drug therapy, although the effects were stronger for initiation. Initiation of a biologic was lower in households where other family members incurred high OOP expenses. Conclusions. The use of biologic therapy for RA is sensitive to benefit generosity and household financial burden. The increasing use of coinsurance rates for specialty drugs (as under Medicare Part D) raises concern about adverse health consequences.

AB - Objectives. To examine the impact of benefit generosity and household health care financial burden on the demand for specialty drugs in the treatment of rheumatoid arthritis (RA). Data Sources/Study Setting. Enrollment, claims, and benefit design information for 35 large private employers during 2000-2005. Study Design. We estimated multivariate models of the effects of benefit generosity and household financial burden on initiation and continuation of biologic therapies. Data Extraction Methods. We defined initiation of biologic therapy as first-time use of etanercept, adalimumab, or infliximab, and we constructed an index of plan generosity based on coverage of biologic therapies in each plan. We estimated the household's burden by summing up the annual out-of-pocket (OOP) expenses of other family members. Principal Findings. Benefit generosity affected both the likelihood of initiating a biologic and continuing drug therapy, although the effects were stronger for initiation. Initiation of a biologic was lower in households where other family members incurred high OOP expenses. Conclusions. The use of biologic therapy for RA is sensitive to benefit generosity and household financial burden. The increasing use of coinsurance rates for specialty drugs (as under Medicare Part D) raises concern about adverse health consequences.

KW - Specialty drugs

KW - household burden

KW - pharmacy benefit design

UR - http://www.scopus.com/inward/record.url?scp=77956604314&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77956604314&partnerID=8YFLogxK

U2 - 10.1111/j.1475-6773.2010.01117.x

DO - 10.1111/j.1475-6773.2010.01117.x

M3 - Article

C2 - 20831715

AN - SCOPUS:77956604314

VL - 45

SP - 1227

EP - 1250

JO - Health Services Research

JF - Health Services Research

SN - 0017-9124

IS - 5 PART 1

ER -