Objectives: To evaluate the impact of specialty pharmacy management on medication adherence, medical utilization, and medical costs for patients with rheumatoid arthritis (RA).
Study Design: Retrospective cohort design.
Methods: We compared outcomes for RA patients who filled prescriptions through a specialty pharmacy and patients who only received their medications through retail pharmacies. Medical and drug utilization data over a 3-year period were extracted from de-identified administrative claims. Patients were identified by RA diagnosis and by prescriptions for etanercept or adalimumab. Primary outcome measures were RA medication adherence; occurrence of office visit, hospitalization, or emergency department (ED) visit; drug costs; and medical costs. Differences between specialty and retail patient groups were evaluated using regression analysis, adjusting for age, sex, region, comorbidity, and concomitant medication use.
Results: Specialty pharmacy patients had significantly higher rates of medication adherence than retail pharmacy patients (P <.0001 for each year). Specialty pharmacy patients were less likely to have an office visit in years 2 and 3 of the study. Differences in hospitalization risk were not significant, but ED risk was lower for specialty pharmacy patients in year 3. Medical costs were significantly lower for specialty pharmacy patients in all 3 years of the study. Pharmacy costs were higher for specialty pharmacy patients due to the higher rate of medication adherence.
Conclusions: Specialty pharmacy management can increase adherence to RA medication therapy, reduce medical resource use, and reduce medical costs. Savings in indirect costs may help offset the increased drug costs associated with better adherence.