title: Cost sharing, family health care burden, and the use of specialty drugs for rheumatoid arthritis.
abstract: OBJECTIVE
  To examine the impact of benefit generosity and household health care financial burden on the demand for specialty drugs in the treatment of rheumatoid arthritis (RA).
  
  
  METHODS
  Enrollment, claims, and benefit design information for 35 large private employers during 2000-2005.
  
  
  METHODS
  We estimated multivariate models of the effects of benefit generosity and household financial burden on initiation and continuation of biologic therapies.
  
  
  METHODS
  We defined initiation of biologic therapy as first-time use of etanercept, adalimumab, or infliximab, and we constructed an index of plan generosity based on coverage of biologic therapies in each plan. We estimated the household's burden by summing up the annual out-of-pocket (OOP) expenses of other family members.
  
  
  RESULTS
  Benefit generosity affected both the likelihood of initiating a biologic and continuing drug therapy, although the effects were stronger for initiation. Initiation of a biologic was lower in households where other family members incurred high OOP expenses.
  
  
  CONCLUSIONS
  The use of biologic therapy for RA is sensitive to benefit generosity and household financial burden. The increasing use of coinsurance rates for specialty drugs (as under Medicare Part D) raises concern about adverse health consequences.
authors.affiliation: School of Public Health, University of Minnesota, 420 Deleware Street SE, MMC729, Minneapolis, MN 55455, USA. pkmandic@umn.edu
authors.forename: Pinar
authors.initials: P
authors.lastname: Karaca-Mandic
authors.forename: Geoffrey F
authors.initials: GF
authors.lastname: Joyce
authors.forename: Dana P
authors.initials: DP
authors.lastname: Goldman
authors.forename: Marianne
authors.initials: M
authors.lastname: Laouri
mesh_terms: D000068879:Adalimumab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000191:economics; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D017047:Cost Sharing / Q000191:economics*; D017281:Cost of Illness; D016527:Drug Costs / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000191:economics; D000068800:Etanercept; D005260:Female; D005382:Financing, Personal / Q000191:economics*; D006264:Health Benefit Plans, Employee / Q000191:economics; D006302:Health Services Research; D006801:Humans; D007074:Immunoglobulin G / Q000191:economics; D007155:Immunologic Factors / Q000191:economics* / Q000627:therapeutic use; D000069285:Infliximab; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D019458:Insurance Coverage / Q000191:economics; D008297:Male; D054524:Medicare Part D / Q000191:economics; D008875:Middle Aged; D015999:Multivariate Analysis; D018124:Receptors, Tumor Necrosis Factor; D014481:United States
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D007155:Immunologic Factors; D018124:Receptors, Tumor Necrosis Factor; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept