title: Consumer cost sharing and use of biopharmaceuticals for rheumatoid arthritis.
abstract: OBJECTIVE
  To evaluate the effect of consumer cost sharing on use of physician-administered and patient self-administered specialty drugs for rheumatoid arthritis.
  
  
  METHODS
  Multivariate statistical analysis of probability and use of physician-administered specialty drugs, patient self-injected specialty drugs, non-biologic disease-modifying anti-rheumatic drugs, and symptom relief drugs. Analyses were conducted for patients enrolling in preferred provider organization (PPO) plans and health maintenance organization (HMO) plans with different cost-sharing requirements, adjusted for patient demographics, health status, and geographical location.
  
  
  METHODS
  Professional, facility, and pharmaceutical claims for beneficiaries of CalPERS, the public employee insurance purchasing alliance in California, for 2008-2009. Consumer cost-sharing requirements were obtained for each type of drug and service for each type of insurance plan.
  
  
  RESULTS
  PPO insurance enrollees face substantially higher cost sharing for physician-administered specialty drugs, compared with HMO enrollees in CalPERS. PPO patients with rheumatoid arthritis are only half as likely as HMO enrollees to choose a physician-administered specialty drug (4.2% vs 9.3%) (P ≤.05), and use 25% less of the drugs if they use any ($10,356 vs $13,678) (P ≤.05). They are 30% more likely to use a self-administered specialty drug than are HMO enrollees (29.3% vs 22.1%) (P ≤.05), and use 35% more of the drugs if any ($16,015 vs $12,378) (P ≤.05).
  
  
  CONCLUSIONS
  Consumer cost sharing reduces the use of physician-administered specialty drugs for rheumatoid arthritis. The higher use of patient self-administered specialty drugs suggests that the disincentives for use of physician-administered drugs were offset by an increased incentive to use self-administered drugs.
authors.affiliation: Berkeley Center for Health Technology, University of California, 247 University Hall, Berkeley, CA 94720-7360, USA. james.robinson@berkeley.edu
authors.forename: James C
authors.initials: JC
authors.lastname: Robinson
mesh_terms: D018501:Antirheumatic Agents / Q000191:economics* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001702:Biopharmaceutics / Q000191:economics*; D002140:California; D017047:Cost Sharing; D006279:Health Maintenance Organizations / Q000191:economics; D006801:Humans; D007345:Insurance Claim Review; D015999:Multivariate Analysis; D011243:Preferred Provider Organizations / Q000191:economics; D011306:Prescription Fees; D012648:Self Care
chemical_list: D018501:Antirheumatic Agents