Cost sharing, family health care burden, and the use of specialty drugs for rheumatoid arthritis

Health Serv Res. 2010 Oct;45(5 Pt 1):1227-50. doi: 10.1111/j.1475-6773.2010.01117.x.


Objectives: To examine the impact of benefit generosity and household health care financial burden on the demand for specialty drugs in the treatment of rheumatoid arthritis (RA).

Data sources/study setting: Enrollment, claims, and benefit design information for 35 large private employers during 2000-2005.

Study design: We estimated multivariate models of the effects of benefit generosity and household financial burden on initiation and continuation of biologic therapies.

Data extraction methods: We defined initiation of biologic therapy as first-time use of etanercept, adalimumab, or infliximab, and we constructed an index of plan generosity based on coverage of biologic therapies in each plan. We estimated the household's burden by summing up the annual out-of-pocket (OOP) expenses of other family members.

Principal findings: Benefit generosity affected both the likelihood of initiating a biologic and continuing drug therapy, although the effects were stronger for initiation. Initiation of a biologic was lower in households where other family members incurred high OOP expenses.

Conclusions: The use of biologic therapy for RA is sensitive to benefit generosity and household financial burden. The increasing use of coinsurance rates for specialty drugs (as under Medicare Part D) raises concern about adverse health consequences.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adalimumab
  • Aged
  • Antibodies, Monoclonal / economics
  • Antibodies, Monoclonal, Humanized
  • Antirheumatic Agents / economics
  • Antirheumatic Agents / therapeutic use
  • Arthritis, Rheumatoid / drug therapy*
  • Cost Sharing / economics*
  • Cost of Illness*
  • Drug Costs / statistics & numerical data*
  • Drug Utilization / economics
  • Etanercept
  • Female
  • Financing, Personal / economics*
  • Health Benefit Plans, Employee / economics
  • Health Services Research
  • Humans
  • Immunoglobulin G / economics
  • Immunologic Factors / economics*
  • Immunologic Factors / therapeutic use
  • Infliximab
  • Insurance Claim Reporting / statistics & numerical data
  • Insurance Coverage / economics
  • Male
  • Medicare Part D / economics
  • Middle Aged
  • Multivariate Analysis
  • Receptors, Tumor Necrosis Factor
  • United States


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Antirheumatic Agents
  • Immunoglobulin G
  • Immunologic Factors
  • Receptors, Tumor Necrosis Factor
  • Infliximab
  • Adalimumab
  • Etanercept