New Research Demonstrates Disproportionate Access to Specialty Drugs by Wage and Race
A review of employer-sponsored health plan data found that non-white and low-wage workers may struggle to access specialty medicines for autoimmune diseases.
For Immediate Release: March 21, 2024
Contact: Michael Pratt, 202-827-2088, mpratt@npcnow.org
Washington, D.C. – New research in The Journal of Managed Care and Specialty Pharmacy
found that low-income and non-white individuals participating in commercial health plans have lower usage of specialty drugs for autoimmune conditions. The research “Specialty Drug Use for Autoimmune Conditions Varies by Race and Wage Among Employees With Employer-Sponsored Health Insurance” was co-authored by Bruce W. Sherman, MD; Rochelle Henderson, PhD; Leah Kamin, MPH; and Sharon Phares, PhD, MPH.
The research, which analyzed claims data from 2018 using the IBM Watson MarketScan database, found that among the 47,839 individuals analyzed who were identified as having an autoimmune condition studied, 11.2% filled at least one specialty prescription. Notably, the prevalence of use was significantly less among Black and Hispanic subpopulations across all wage categories except the highest wage category.
Against a backdrop of increasing diagnoses of autoimmune diseases, employer efforts to manage specialty medicine costs by implementing increased cost-sharing from enrollees may have inadvertently contributed to disparities in the use of these medications. The research showed a lower prevalence of specialty medicine use among low-wage and non-white individuals with autoimmune conditions.
“In this rigorously designed analysis, we demonstrate that race, ethnicity, and wage-related disparities exist in specialty medication use in the treatment of autoimmune conditions among employees with employer-sponsored insurance, which may negatively impact clinical outcomes,” stated Bruce Sherman, a co-author of the recent study. “As a claims-based analysis, our findings do not provide insight into the root cause of the observed findings but do raise questions about the nature of the patient-clinician interaction in terms of medical mistrust and implicit bias, in addition to unmet social needs priorities and access and affordability concerns. Further research can help to identify – and ultimately mitigate – the primary contributors to the observed findings.”
“The path to achieving equity in specialty care medicine usage is challenging. While the factors contributing to lower specialty medicine usage by low-income and non-white patients for autoimmune conditions are likely multifactorial, the research suggests that employers are in a unique role to mitigate some of these observed disparities,” said Kimberly Westrich, MA, Chief Strategy Officer of the National Pharmaceutical Council. “A one-size-fits-all approach to health benefit design is not the path to equity, and there are steps employers can take to implement more equitable benefit designs.”
Related Materials:
- “Specialty drug and health care utilization vary by wage level in employer-sponsored health plans,” The Journal of Managed Care and Specialty Pharmacy, Bruce W. Sherman, MD, Brian Sils, MPP, Leah Kamin, MPH, and Kimberly Westrich, MA
- “Ignoring inequitable benefit design is not an option,” Benefits Pro, Bruce W. Sherman, MD, and Kimberly Westrich, MA
About the National Pharmaceutical Council
The National Pharmaceutical Council (NPC) is a health policy research organization dedicated to the advancement of good evidence and science, and to fostering an environment in the United States that supports medical innovation. Founded in 1953 and supported by the nation's major research-based pharmaceutical companies, NPC focuses on research development, information dissemination and education on the critical issues of evidence, innovation and the value of medicines for patients. For more information, visit www.npcnow.org and follow NPC on LinkedIn.