OBJECTIVES

: Adherence to specialty medications is negatively impacted when high cost sharing is placed on the patients. Downstream effects of medication non-adherence are related to higher systemic level healthcare costs, which is borne by payers. Therefore, this study explores the payer impact of missed specialty medication dose on total healthcare cost (THC).

METHODS

: Cohorts of patients were created from the Marketscan commercial claims database between 1/1/2014-12/31/2014 respective of five diseases states: cystic fibrosis (CF), alpha-1 antitrypsin deficiency (ALPHA), eosinophilic asthma (EA), primary humoral immunodeficiency (PIDD) and human immunodeficiency virus (HIV). Inclusion criteria required at least one claim with a diagnosis code and at least one claim for a specialty drug associated with the disease. Patients were followed monthly and split into two groups based on whether they had a January specialty drug claim. Measures included payer THC not including the specialty drug, time, and group. Random effects model was used to assess a significant difference in the THC between these groups for each disease state.

RESULTS

: The average monthly payer cost share for patients missing their January medication for CF were $834 lower ($5063 vs $5897, p=0.57), $238 higher for ALPHA ($2100 vs $1862, p=0.80), $51 higher for EA ($1588 vs $1537, p=0.66), $1,669 higher for PIDD ($4504 vs $2835, p<0.01), and $319 higher for HIV ($1600 vs $1281, p<0.01).

CONCLUSIONS

: PIDD and HIV patients showed a significant THC increase possibly due to a worsening of their disease after missing a medication dose. Historically, CF patients are 61% compliant, with decreased compliance through the year, possibly explaining the inconsistent non-significant effect. Research has shown better medication adherence to medications had a positive economic impact for chronic diseases. As the THC increases, payers need to find strategies to keep specialty drug patients compliant to reduce the impact on other healthcare cost.