OBJECTIVES: Specialty drugs are innovative, high-cost agents used to treat complex chronic conditions such as rheumatoid arthritis (RA), multiple sclerosis (MS), and chronic myeloid leukemia (CML). Unlike retail pharmacies, specialty pharmacies offer additional services (finding financial assistance with out-of-pocket costs, administration instructions, etc.) and have been associated with higher medication adherence in prior studies. Despite these benefits, little is known on the extent of specialty pharmacy use in the Medicare population. This study sought to examine the use of specialty pharmacy among Medicare beneficiaries receiving Part D specialty drugs for RA, MS, and CML.

METHODS: We used 100% Medicare claims data from 2014-2019, the latest available data prior to the COVID-19 pandemic. Among Medicare fee-for-service beneficiaries receiving a Part D specialty drug for each of the 3 conditions, we report the percentage of patients filling their prescription via a specialty pharmacy in each calendar year. Trends in specialty pharmacy use were examined separately for patients with RA, MS, and CML.

RESULTS: Between 2014 and 2017, the rate of specialty pharmacy use increased among Medicare beneficiaries with RA (14.4% to 28.2%, p<0.001), MS (25.1% to 47.1%, p<0.001), and CML (21.1% to 32.1%, p<0.001). Thereafter the rate of specialty pharmacy use remained relatively stable for each group through 2019 (RA: 31.2 %, MS: 48.9%, CML: 34.6%). Across all three conditions, Black patients had lower rates of specialty pharmacy use compared to Whites (p<0.001).

CONCLUSIONS: Specialty pharmacy use has increased over time in the Medicare population taking specialty drugs for RA, MS, and CML. However, approximately two-thirds of RA and CML patients and half of MS patients are not using a specialty pharmacy. Policymakers should consider approaches to encourage specialty pharmacy use and perhaps reassess the Any Willing Pharmacy (AWP) provision under Medicare Part D rules which prohibits plans from mandating specialty pharmacy use in this population.