OBJECTIVES: To evaluate whether the use of specialty pharmacy services within a health plan improves outcomes in inflammatory conditions while reducing overall health care costs, when compared to non-specialty pharmacy care.

METHODS: A retrospective, matched cohort study was conducted for members receiving inflammatory condition medications from a specialty pharmacy (N=20,186), compared to a retail pharmacy (N=3,379). Pharmacy and medical claims from 2021 and 2022 were evaluated. Each member was tracked for one year, using their most recent year of activity. Due to inherent differences in the populations, coarsened exact matching (CEM) methods were used to match members using confounders including demographics, Elixhauser comorbidity score, claim year, and prior therapies. Statistically significant differences were evaluated using t and chi-squared tests. The populations were compared in terms of adherence, total medical cost, and other secondary outcomes, such as ER and hospital visits.

RESULTS: Average annual medical cost per member was $900 lower for the specialty pharmacy cohort ($10,112 vs $11,005, p=0.0085). The specialty pharmacy group had higher optimal adherence (measured as PDC > 80%), although the difference was not statistically significant (77.0% v 76.7%, p=0.7875). Occurrence of inpatient visits (6.77% v 8.58%, p=0.0173) and ER visits (26.0% v 30.6%, p=0.0016) were also lower for the specialty pharmacy cohort. The specialty pharmacy cohort had higher utilization of digital platforms (77.5% v 72.7%, p<0.0001), and more frequent digital engagement (24.7 v 17.5 sessions, p<0.0001).

CONCLUSIONS: Members receiving medications for inflammatory conditions via a specialty pharmacy had lower total medical costs. Adherence was higher in the specialty pharmacy cohort but was not statistically significant. They also had significantly higher digital engagement. The additional services offered by the specialty pharmacy such as counseling, ongoing education and engagement from nurses and pharmacists may lead to better overall medical management and fewer hospital/ER visits.