Specialty Pharmacy Services Produce Better Health Outcomes for RA Patients

In a retrospective analysis, researchers concluded that rheumatoid arthritis patients had better outcomes when they filled their prescriptions through a mail-order specialty pharmacy rather than a retail pharmacy.

Researchers recently concluded in a study published in the November 2012 issue of The American Journal of Pharmacy Benefits that filling a self-injectable biologic for the treatment of rheumatoid arthritis (RA) through a mail-order specialty pharmacy was less expensive overall and produced better health outcomes than if the drugs were filled through a community-based retail pharmacy.

The retrospective study examined 4388 RA patients managed through Medco Health Solutions (now Express Scripts) who filled at least 1 prescription for adalimumab or etanercept over a 3-year period from January 1, 2006, through December 31, 2008 and met the inclusion criteria for the final study sample. Patients were grouped into specialty or retail cohorts based on the pharmacy channel through which they filled their prescriptions for the study period and were evaluated for medication adherence, medical utilization, and medical costs.

Results of the study revealed that patients who filled their prescriptions through a specialty pharmacy had significantly higher levels of medication adherence than patients who received their medications from a retail pharmacy. Higher adherence meant that prescription drug costs were significantly greater for specialty patients in all 3 years of the study, but average medical costs (excluding prescription drug costs) were significantly lower for specialty pharmacy patients than for retail patients.

The use of all medical resources for patients filling their RA medications did not seem to be consistently affected by pharmacy channel. Although specialty patients were less likely to have an office visit in years 2 and 3 of the study, the mean number of office visits per patient did not differ significantly between the 2 groups, nor did the risk of hospitalization. In year 3, however, researchers observed that the risk of an emergency department visit for specialty patients was significantly lower than that for retail patients.

The researchers point out that looking at adherence and medical utilization through a retrospective analysis helps them determine overall effectiveness of a channel, but does not tell them why these results have occurred. “This design gives the results broad external validity when evaluating the relative impact of these two pharmacy types,” they wrote. “However, it limits our ability to identify which features of specialty pharmacy are most influential in improving adherence and reducing medical costs, because the features cannot be varied independently.”