(214) Factors associated with variation in drug costs in states with prescription drug affordability boards

Background: : Five states have created similar prescription drug affordability boards (PDABs) to address concerns on drug affordability, which may be influenced by a number of factors related to patient insurance/benefit design and characteristics. At present, there are limited data to fully inform PDAB deliberations, thus this study aims to investigate factors associated with variations in drug spending.

Objective: : Describe factors which contribute to the variation in drug spend in states with similar PDABs.

Methods: : The IQVIA PharMetrics Plus closed claims database was used to conduct a retrospective analysis of pharmacy and medical claims (2018-2022) for patients on select drugs to assess plan spend and patient liability by patient and insurance related factors including the charlson comorbidity index (CCI), cost sharing types (copays, deductibles and coinsurance), plan type (e.g. PPO, high-deductible health plan, etc.) and funding (fully-insured (FI) vs. self-funded (SF)). Based on drugs generally eligible for review by state PDABs, 20 drugs used to treat rheumatoid arthritis, psoriasis, multiple sclerosis and cancer were included. Patients were required to have at least 3 claims throughout a calendar year for a given drug and be continuously enrolled in a SF or FI plan throughout at least one calendar year to be included in the study. Descriptive statistics were used to assess plan drug spending and patient liabilities for drugs.

Results: : 174,761 patients were included, of which 12,935 patients were located in states with PDABs (CO, MD, MN, OR, WA). Nationwide there was significant variation in both median annual plan spend amounts ($57,826 [IQR: $35,502, $77,395]) and patient liability ($624 [IQR: $200, $1,717]). Those patients with a low deductible, self-funded, point-of-service plan, with copays had significantly lower median patient liabilities than those patients with a fully-insured high-deductible plan and coinsurance ($338 vs. $6,469, p < 0.001). Among PDAB states, high-deductible plans had consistently the largest median annual patient liabilities (range: $2,039 to $3,600) while PPOs generally had the lowest (range: $0 to $874). Comorbidities was a substantial factor in payer spending with differences in median plan paid costs between CCI scores of 0 to 3+ of >$5,000 in MN to >$20,000 in OR.

Conclusions: : Variations in health plan drug spend and patient liabilities are shaped by the interplay of insurance benefit designs and patient characteristics. State-level solutions for drug affordability require a multi-faceted approach to address these complex associations.

Sponsorship:: Genentech, Inc.