Specialty Pharmacy Trends Report: Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disorder that primarily affects small
joints in the hands and feet. RA affects the lining of joints, causing painful swelling that may result in bone erosion or joint deformity. According to the Arthritis Foundation, an estimated 1.3 million people in the United States have RA; nearly 3 times as many women are diagnosed with the disease compared with men. According to the Centers for Disease Control and Prevention, arthritis and other rheumatic conditions cost the US healthcare system $127.8 billion total, with $80.8 billion in medical care expenditures and $47 billion in lost wage earnings.

Medications for RA seek to do 1 of 2 things: (1) help control and limit joint damage, including disease-modifying antirheumatic drugs (DMARDs) and biologics; or (2) treat pain and inflammation, but do not limit joint damage, such as corticosteroids and nonsteroidal anti-inflammatory drugs. In some cases, DMARDs are prescribed as injections; biologics may be taken by injection, intravenously, or orally. In extreme circumstances, joint surgery replacement may be necessary.

The survey participants were divided on how involved they are in reporting adherence and/or compliance on the use of RA medications obtained through specialty pharmacy, with 25.93% reporting “a moderate amount” and another 25.93% reporting “never” (Figure 1).

The majority of survey respondents (59.26%) said 0% to 25% of specialty pharmaceuticals for
treatment of RA require in-office administration of the drug, while 22.22% of participants said 26% to 50% (Figure 2).

Most of the survey participants (53.7%) treat patients with RA with combination therapies, while 24.07% said they treat patients with a single agent and the remaining 22.22% said they were unsure of the treatment (Figure 3).

When the survey participants were asked if they utilize comparative effectiveness research when examining RA drugs, 42.59% said “yes,” 31.48% said they were unsure, and 25.93% said “no” (Figure 4).

Specialty pharmacy is a burgeoning field that continues to be of importance for managed care professionals. With the rates of chronic, high-cost conditions increasing, payers are eager to find ways to diffuse costs, while also providing patients with the best care possible. First Report Managed Care partnered with the National Association of Specialty Pharmacy to put together this Specialty Pharmacy Trends Report.

The information for this trends report was generated through a comprehensive survey developed via the collaborative efforts of an Advisory Panel of key thought leaders and the First Report Managed
Care editorial staff. This survey was then sent to a diverse pool of specialty pharmacy professionals. This is part 3 of a 3-part series we bring to you on the climate of specialty pharmacy as it relates to the managed markets. We hope that you find the information presented to be practical, informative, and compelling. We hope the survey results serve as a resource you can use in making future management decisions.

Survey Participant Demographics

Key thought leaders in the field of specialty pharmacy have provided the information collected in this Specialty Pharmacy Trends Report series. The following are the demographic responses, providing a snapshot of the survey participants and the organizations for which they are affiliated.

The Northeast is home to most of the survey participants (33.93%), while 28.57% of participants are in the Midwest, 10.71% in the Southeast, 10.71% in the Pacific, 10.7% in National regions, 3.57% in the Mountain region, and 1.79% said “not applicable.”

The majority of the survey respondents (60.71%) have a PharmD degree, while 39.29% have a BS in
Pharmacy, 17.86% have an MBA, 10.71% have an MS, and 5.36% have a PhD. A significant majority of survey participants (53.57%) have an RPh certification, while 17.86% have a BCPS, and 12.5% have a CSP.

When asked how long they have been in the specialty pharmacy field, 35.71% of survey participants said 0 to 5 years, while 28.57% said 11 to 20 years, and 26.79% said 6 to 10 years.

Mail-order specialty pharmacy is the primary facility of work for 23.21% of the survey participants. An additional 16.07% said their primary facility of work is an academic institution (not a university hospital), another 16.07% said a managed care organization, 14.29% said a retail specialty pharmacy,
and 10.71% said a consulting firm.

When asked what type of specialty pharmacy they are involved with, 26.79% of the survey respondents said independently owned (nonretail) and another 26.79% said pharmacy benefits manager. Another 16.07% of the survey respondents are involved with a health plan-owned specialty pharmacy and 14.29% are retail pharmacy owned.

Most of the survey respondents (39.29%) reported that they have 1% to 25% of patient interaction time on a monthly basis, while 28.57% said their role does not currently involve patient interaction.

When the survey participants were asked to select the top 5 therapeutic categories with which they are most involved, and with the option to select up to 5 areas, the results were the following:
     • Oncology (69.64%)
     • Rheumatoid arthritis (67.86%)
     • Hepatitis C (64.29%)
     • Multiple sclerosis (50%)
     • Diabetes (37.5%)
     • Crohn’s disease (35.71%)
     • Psoriasis/Psoriatic arthritis (35.71%)
     • HIV/AIDS (25%)
     • Hemophilia (23.21%)
     • Immunoglobulins (12.5%)
     • Cystic fibrosis (8.93%)
     • Hereditary angioedema (5.36%)
     • Gout (3.57%)
     • Infertility (1.79%)