Specialty drug use for autoimmune conditions varies by race and wage among employees with employer-sponsored health insurance

Published in the Journal of Managed Care and Specialty Pharmacy, this study found that low-income and non-white individuals participating in commercial health plans have lower usage of specialty drugs for autoimmune conditions.


Bruce W. Sherman, MD; Rochelle Henderson, PhD; Leah Kamin, MPH; and Sharon Phares, PhD, MPH


The Journal of Managed Care and Specialty Pharmacy


To assess the association of race and ethnicity and wage status on the use of specialty medicines and adherence patterns among employees with autoimmune conditions enrolled in employer-sponsored health insurance.


  • Among the 47,839 individuals analyzed who were identified as having an autoimmune condition studied, 11.2% filled at least one specialty prescription. 
  • Prevalence of use was significantly less among Black and Hispanic subpopulations across all wage categories except the highest wage category.
  • Researchers found lower use of specialty medicines among Black patients with autoimmune conditions compared to White patients: 
    • ≤$35,000 annually: 4.9% in Black patients vs. 9.4% in White patients
    • $35,000-$47,000 annually: 5.5% in Black patients vs. 10.6% in White patients
    • $47,000-$71,000 annually: 8.5% in Black patients vs. 11.1% in White patients
    • $71,000-$106,000: 9.1 in Black patients vs. 12.7% in White patients
  • Hispanic patients also had significantly lower use rates of specialty medicines compared to White patients:
    • ≤$35,000: 4.5% in Hispanic patients vs. 9.4% in White patients
    • $35,000-$47,000: 6.1% in Hispanic patients vs. 10.6% in White patients
    • $71,000-$106,000: 8.6% in Hispanic patients vs. 12.7% in White patients


  • Previous research demonstrates that fewer low-wage workers with autoimmune conditions use specialty medications when compared to higher-wage earners.
  • When race and ethnicity are factored in, disparities in use of specialty medicines among Black and Hispanic individuals are exacerbated. 
  • Most employer-sponsored health insurance incorporates a “one size fits all” approach to health plan premiums, irrespective of employee income.
  • Employer efforts to manage specialty medicine costs by implementing increased cost-sharing from enrollees may contribute to disparities in the use of of specialty drugs.

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JMCP March 2024

Read the full study now.

JMCP - March 2024