Effectiveness of step therapy policies for specialty pharmaceuticals in immune disorders

Figures & data

Figure 1. Cohort identification for the policy change versus all other analysis.

Figure 2. Cohort identification for the policy change versus matched plans.

Figure 3. Pre–Post analysis inclusion/exclusion criteria and follow up time.

Figure 4. Percentage of patients with ≥1 infusion biologic claim by step therapy status and cohort.

Table 1. Definition of step therapy (ST) plans and comparison cohorts and resulting effect on use of infusion products.

Cohort	ST policy cohort	Sample size (N)	Comparison cohort	Sample size (N)	Net resulting change in infusion patient share*
Population	All ST plans in place throughout 2010	8098	All other biologic claims in 2010 not within ST plans	266,397	−5.1% (25.9% in ST – 31.0% in all other) (p < 0.0001)**
Matched	All ST plans in place throughout 2010	8098	All other biologic claims in 2010 in randomly selected region and size matched plans that do not have ST policy in place	10,280	+7.0% (25.9% in ST – 18.9% in matched) (p < 0.0001)**
Pre/post	All ST plans in place 1 January 2006 to 30 April 2011 with data 365 days after policy implementation	252	All ST plans in place 1 January 2006 to 30 April 2011 with data 365 days before policy implementation	252	+2.8% (15.2% post – 12.4% pre) (p = 0.0522)***

*Positive values imply a shift toward infusion products after policy implementation in the pre–post, or a higher share in the comparator group in the population and matched analyses. Negative values imply a shift toward subcutaneous.

**Chi square test.

***McNemar’s test.