Impact of Cost Sharing on Specialty Drug Utilization among Medicare Beneficiaries
Specialty drugs typically represent significant medical advances, either in the form of novel approaches for the treatment of complex chronic conditions or because they target diseases with few prior treatment options. Specialty drugs have been the focus of payer efforts to control spending because they are often accompanied by higher costs than traditional medications, accounting for nearly one third of total prescription drug spending in the U.S. in 2013. Prescription drug plans requiring high specialty drug cost sharing (e.g., up to 33% coinsurance) are becoming increasingly common, particularly among Medicare patients. Despite these market trends, the impact of patient cost sharing on specialty drug utilization is unclear. Available studies have been limited to privately insured patients from a period when cost sharing was not at the levels seen in today’s marketplace. This session will focus on new research examining cost sharing and drug utilization for three of the top drivers of specialty drug spending in Medicare patients: cancer, rheumatoid arthritis, and multiple sclerosis.