EBRI Issue Brief
The Relationship Between Health Plan Type, Use of Specialty Medications, and Worker Productivity
Specialty medications have piqued the attention of employers because spending on specialty medications has been increasing. In 2012, specialty medications accounted for 24 percent of total drug spending in the commercial market, but by 2016 specialty medications accounted for 36 percent. By 2020, specialty medications are expected to account for nearly one-half of total drug spending in the commercial market. Managing specialty medications is considered one of the most effective tactics when it comes to controlling health care costs.
In this Issue Brief, the Employee Benefit Research Institute (EBRI) examines the impact of plan type on use of specialty medications. This paper also focuses on the impact that use of specialty medications both among workers and their dependents has on worker productivity. The analysis was conducted on nearly 100,000 unique individuals with rheumatoid arthritis (RA), Crohn's disease, ulcerative colitis, psoriasis, and multiple sclerosis (MS) using data from the Truven Health Analytics MarketScan® Research Commercial Claims and Encounters Database.
Use of specialty medications among individuals with multiple sclerosis (MS): ?
- Among individuals with MS, there was no difference in the likelihood of filling a prescription for a specialty medication by type of health plan. However, among individuals with MS that had filled a specialty medication prescription, individuals with preferred provider organization / point of service (PPO/POS) and health reimbursement arrangement (HRA) plans used more specialty medications than those with health maintenance organization / exclusive provider organization (HMO/EPO) plans. There was no difference between those with health savings account (HSA)-eligible health plans and those with HMO/PPO coverage.
Use of specialty medications among individuals with rheumatoid arthritis (RA), Crohn's disease, ulcerative colitis, and psoriasis: ?
- Plan type had no impact on whether any specialty medications were used, with one exception. Among individuals with RA, those with an HRA were less likely than those in HMO/EPO plans to use any specialty medications. Among individuals that had filled specialty medication prescriptions, we found mixed effects on the number of fills. For the most part, there were no differences in the number of fills by plan type. However, among individuals with RA, those in HRA plans filled fewer specialty medications than those in HMO/EPO plans. Among individuals with Crohn’s disease, those in PPO/POS plans used more specialty medications than those in HMO/EPO plans.
Use of Specialty Medications and Worker Productivity ?
Any Use: We found few instances where productivity was affected by use of specialty medications. We did not find any relationship between any use of specialty medication and any use of sick or vacation leave, or number of days absent. We also did not find that any use of specialty medications affected whether a worker took short-term disability. However, we did find that any use of specialty medications reduced the number of days on short-term disability for workers with Crohn’s disease by 37.6 days and for workers with psoriasis by 42.6 days. ?
Number of Medications: Regarding the impact of the number of specialty medications fills on productivity, we did not find an impact on the likelihood of taking any days off or on the likelihood of being on short-term disability. There was evidence that a higher number of specialty medication fills increased the number of absentee days for individuals with Crohn’s disease and psoriasis. However, the magnitude of these effects was quite small, increasing absenteeism by 0.53 days for those with Crohn’s disease and by 0.25 days for those with psoriasis. There was also evidence that a higher number of specialty medication fills increased the length of short-term disability for individuals with MS by 5.6 days. ?
Dependent Use: We also examined the impact of use of specialty medications on worker productivity by examining whether worker productivity was affected by use of specialty medications among dependents. We tested this by examining the impact of spousal use of specialty medications for married workers. We found nearly no evidence that any use of specialty medications reduced worker absenteeism with one exception—among spouses using specialty medications for ulcerative colitis, workers were absent from work 6.5 fewer days. With respect to the number of specialty medications filled among those who had filled at least one prescription, we found mixed results. There was no impact on worker absenteeism among spouses with Crohn’s disease, psoriasis or MS. Higher use of specialty medications reduced absenteeism among workers with spouses treated for ulcerative colitis, but it increased absenteeism among workers with spouses treated for RA.