Effects of specialty pharmacy care on health outcomes in multiple sclerosis

Jun Tang, James Bailey, Cyril Chang, Richard Faris, Song Hee Hong, Michael Levin, Junling Wang

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND: Increasingly, third-party payers are requiring patients with multiple sclerosis (MS) to participate in specialty pharmacy management programs to improve their adherence to their prescribed medications. The effects of specialty pharmacy care on MS clinical outcomes have not yet been comprehensively examined in the literature. OBJECTIVE: To compare the effectiveness of specialty pharmacy care and usual community pharmacy care MS outcomes. METHODS: Inpatient, outpatient, and pharmacy claims for patients with MS were extracted from a major national pharmacy benefit management company’s databases for this retrospective cohort study. Enrollees with continuous medical and pharmacy benefits were followed for 3 years. MS relapse status was defined by a specific algorithm and was compared in patients who had specialty pharmacy care and those with usual community pharmacy care. The outcome measures included time to the first and second disease relapses and the number of relapses. Kaplan-Meier method and Cox proportional hazards regression analyses were performed on the time to first and second relapses, and generalized linear regression models were performed on the number of disease relapses. RESULTS: The study cohort included 1731 eligible patients with MS, of whom 1427 received specialty pharmacy care. During the study period, between 2006 and 2009, 1634 relapses were identified, with a mean annual relapse rate of 0.3 among the specialty pharmacy care group versus 0.4 among the usual pharmacy care group. Specialty pharmacy care was associated with a lower risk for disease relapse, with a hazard ratio (HR) of 0.73 (95% confidence interval [CI], 0.607-0.871) for the first relapse and HR of 0.78 (95% CI, 0.610-1.002) for the second relapse. When controlling for demographics, comorbidities, and index medications, specialty pharmacy care was associated with a lower risk for disease relapse with HR of 0.82 (95% CI, 0.680-0.985) for first relapse versus usual pharmacy care. The time to second relapse was not significantly different between the 2 groups in the unadjusted and adjusted Cox regression models. In addition, a generalized linear regression model showed that specialty pharmacy care, index age, geographic North region, 3-year Chronic Disease Score, and Elixhauser comorbidity measure were significantly associated with the number of disease relapses. CONCLUSION: These results show that specialty pharmacy care is associated with a significantly lower risk for disease relapse in patients with MS (specifically the first relapse) and fewer relapses compared with usual community pharmacy care.

Original languageEnglish (US)
Pages (from-to)420-428
Number of pages9
JournalAmerican Health and Drug Benefits
Volume9
Issue number8
StatePublished - Nov 1 2016

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Multiple Sclerosis
Delivery of Health Care
Recurrence
Pharmacies
Linear Models
Health outcomes
Multiple sclerosis
Relapse
Confidence Intervals
Comorbidity
Cohort Studies
Health Insurance Reimbursement
Proportional Hazards Models
Inpatients
Chronic Disease
Outpatients
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Health Policy
  • Strategy and Management

Cite this

Effects of specialty pharmacy care on health outcomes in multiple sclerosis. / Tang, Jun; Bailey, James; Chang, Cyril; Faris, Richard; Hong, Song Hee; Levin, Michael; Wang, Junling.

In: American Health and Drug Benefits, Vol. 9, No. 8, 01.11.2016, p. 420-428.

Research output: Contribution to journalArticle

Tang, J, Bailey, J, Chang, C, Faris, R, Hong, SH, Levin, M & Wang, J 2016, 'Effects of specialty pharmacy care on health outcomes in multiple sclerosis', American Health and Drug Benefits, vol. 9, no. 8, pp. 420-428.
Tang, Jun ; Bailey, James ; Chang, Cyril ; Faris, Richard ; Hong, Song Hee ; Levin, Michael ; Wang, Junling. / Effects of specialty pharmacy care on health outcomes in multiple sclerosis. In: American Health and Drug Benefits. 2016 ; Vol. 9, No. 8. pp. 420-428.
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title = "Effects of specialty pharmacy care on health outcomes in multiple sclerosis",
abstract = "BACKGROUND: Increasingly, third-party payers are requiring patients with multiple sclerosis (MS) to participate in specialty pharmacy management programs to improve their adherence to their prescribed medications. The effects of specialty pharmacy care on MS clinical outcomes have not yet been comprehensively examined in the literature. OBJECTIVE: To compare the effectiveness of specialty pharmacy care and usual community pharmacy care MS outcomes. METHODS: Inpatient, outpatient, and pharmacy claims for patients with MS were extracted from a major national pharmacy benefit management company’s databases for this retrospective cohort study. Enrollees with continuous medical and pharmacy benefits were followed for 3 years. MS relapse status was defined by a specific algorithm and was compared in patients who had specialty pharmacy care and those with usual community pharmacy care. The outcome measures included time to the first and second disease relapses and the number of relapses. Kaplan-Meier method and Cox proportional hazards regression analyses were performed on the time to first and second relapses, and generalized linear regression models were performed on the number of disease relapses. RESULTS: The study cohort included 1731 eligible patients with MS, of whom 1427 received specialty pharmacy care. During the study period, between 2006 and 2009, 1634 relapses were identified, with a mean annual relapse rate of 0.3 among the specialty pharmacy care group versus 0.4 among the usual pharmacy care group. Specialty pharmacy care was associated with a lower risk for disease relapse, with a hazard ratio (HR) of 0.73 (95{\%} confidence interval [CI], 0.607-0.871) for the first relapse and HR of 0.78 (95{\%} CI, 0.610-1.002) for the second relapse. When controlling for demographics, comorbidities, and index medications, specialty pharmacy care was associated with a lower risk for disease relapse with HR of 0.82 (95{\%} CI, 0.680-0.985) for first relapse versus usual pharmacy care. The time to second relapse was not significantly different between the 2 groups in the unadjusted and adjusted Cox regression models. In addition, a generalized linear regression model showed that specialty pharmacy care, index age, geographic North region, 3-year Chronic Disease Score, and Elixhauser comorbidity measure were significantly associated with the number of disease relapses. CONCLUSION: These results show that specialty pharmacy care is associated with a significantly lower risk for disease relapse in patients with MS (specifically the first relapse) and fewer relapses compared with usual community pharmacy care.",
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T1 - Effects of specialty pharmacy care on health outcomes in multiple sclerosis

AU - Tang, Jun

AU - Bailey, James

AU - Chang, Cyril

AU - Faris, Richard

AU - Hong, Song Hee

AU - Levin, Michael

AU - Wang, Junling

PY - 2016/11/1

Y1 - 2016/11/1

N2 - BACKGROUND: Increasingly, third-party payers are requiring patients with multiple sclerosis (MS) to participate in specialty pharmacy management programs to improve their adherence to their prescribed medications. The effects of specialty pharmacy care on MS clinical outcomes have not yet been comprehensively examined in the literature. OBJECTIVE: To compare the effectiveness of specialty pharmacy care and usual community pharmacy care MS outcomes. METHODS: Inpatient, outpatient, and pharmacy claims for patients with MS were extracted from a major national pharmacy benefit management company’s databases for this retrospective cohort study. Enrollees with continuous medical and pharmacy benefits were followed for 3 years. MS relapse status was defined by a specific algorithm and was compared in patients who had specialty pharmacy care and those with usual community pharmacy care. The outcome measures included time to the first and second disease relapses and the number of relapses. Kaplan-Meier method and Cox proportional hazards regression analyses were performed on the time to first and second relapses, and generalized linear regression models were performed on the number of disease relapses. RESULTS: The study cohort included 1731 eligible patients with MS, of whom 1427 received specialty pharmacy care. During the study period, between 2006 and 2009, 1634 relapses were identified, with a mean annual relapse rate of 0.3 among the specialty pharmacy care group versus 0.4 among the usual pharmacy care group. Specialty pharmacy care was associated with a lower risk for disease relapse, with a hazard ratio (HR) of 0.73 (95% confidence interval [CI], 0.607-0.871) for the first relapse and HR of 0.78 (95% CI, 0.610-1.002) for the second relapse. When controlling for demographics, comorbidities, and index medications, specialty pharmacy care was associated with a lower risk for disease relapse with HR of 0.82 (95% CI, 0.680-0.985) for first relapse versus usual pharmacy care. The time to second relapse was not significantly different between the 2 groups in the unadjusted and adjusted Cox regression models. In addition, a generalized linear regression model showed that specialty pharmacy care, index age, geographic North region, 3-year Chronic Disease Score, and Elixhauser comorbidity measure were significantly associated with the number of disease relapses. CONCLUSION: These results show that specialty pharmacy care is associated with a significantly lower risk for disease relapse in patients with MS (specifically the first relapse) and fewer relapses compared with usual community pharmacy care.

AB - BACKGROUND: Increasingly, third-party payers are requiring patients with multiple sclerosis (MS) to participate in specialty pharmacy management programs to improve their adherence to their prescribed medications. The effects of specialty pharmacy care on MS clinical outcomes have not yet been comprehensively examined in the literature. OBJECTIVE: To compare the effectiveness of specialty pharmacy care and usual community pharmacy care MS outcomes. METHODS: Inpatient, outpatient, and pharmacy claims for patients with MS were extracted from a major national pharmacy benefit management company’s databases for this retrospective cohort study. Enrollees with continuous medical and pharmacy benefits were followed for 3 years. MS relapse status was defined by a specific algorithm and was compared in patients who had specialty pharmacy care and those with usual community pharmacy care. The outcome measures included time to the first and second disease relapses and the number of relapses. Kaplan-Meier method and Cox proportional hazards regression analyses were performed on the time to first and second relapses, and generalized linear regression models were performed on the number of disease relapses. RESULTS: The study cohort included 1731 eligible patients with MS, of whom 1427 received specialty pharmacy care. During the study period, between 2006 and 2009, 1634 relapses were identified, with a mean annual relapse rate of 0.3 among the specialty pharmacy care group versus 0.4 among the usual pharmacy care group. Specialty pharmacy care was associated with a lower risk for disease relapse, with a hazard ratio (HR) of 0.73 (95% confidence interval [CI], 0.607-0.871) for the first relapse and HR of 0.78 (95% CI, 0.610-1.002) for the second relapse. When controlling for demographics, comorbidities, and index medications, specialty pharmacy care was associated with a lower risk for disease relapse with HR of 0.82 (95% CI, 0.680-0.985) for first relapse versus usual pharmacy care. The time to second relapse was not significantly different between the 2 groups in the unadjusted and adjusted Cox regression models. In addition, a generalized linear regression model showed that specialty pharmacy care, index age, geographic North region, 3-year Chronic Disease Score, and Elixhauser comorbidity measure were significantly associated with the number of disease relapses. CONCLUSION: These results show that specialty pharmacy care is associated with a significantly lower risk for disease relapse in patients with MS (specifically the first relapse) and fewer relapses compared with usual community pharmacy care.

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