Benefit design and specialty drug use.
In this paper we examine spending by privately insured patients with four conditions often treated with specialty drugs: cancer, kidney disease, rheumatoid arthritis, and multiple sclerosis. Despite having employer-sponsored health insurance, these patients face substantial risk for high out-of-pocket spending. In contrast to traditional pharmaceuticals, we find that specialty drug use is largely insensitive to cost sharing, with price elasticities ranging from 0.01 to 0.21. Given the expense of many specialty drugs, care management should focus on making sure that patients who will most benefit receive them. Once such patients are identified, it makes little economic sense to limit coverage.
Goldman
Dana P
DP
Health Economics at RAND in Santa Monica, California, USA. dgoldman@rand.org
Joyce
Geoffrey F
GF
Lawless
Grant
G
Crown
William H
WH
Willey
Vincent
V
D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics; D016527:Drug Costs; D005102:Health Expenditures; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D007674:Kidney Diseases / Q000188:drug therapy* / Q000191:economics; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000191:economics; D009369:Neoplasms / Q000188:drug therapy* / Q000191:economics; D040841:Resource Allocation; D014481:United States