Grant #: 75136
Grantee Institution: University of Washington
Principal Investigator: Anirban Basu, Ph.D.
Data set: Health Care Cost Institute
Grant Period: 12/15/17 – 12/14/18
Budget: $149,872

The goal of this project is to provide evidence to policymakers and health plans to assist them in setting priorities that optimally protect patients who take specialty medications. Specialty drugs, while an important therapeutic advancement, are costly. Seven states and the District of Columbia have capped out-of-pocket (OOP) payments in employer-sponsored plans. The impact of such caps is unknown. In their study, the researchers will examine the effect of state mandated cost-sharing caps on patient and health plan pharmacy and medical spending. Specifically, they will (1) examine the impact of state cost-sharing caps on patient OOP spending for specialty medications and for other medical care; (2) assess the impact of state cost-sharing caps on health plan spending for specialty medications and for other medical care; and (3) determine whether Aims 1-2 effects depend on the different characteristics of the state-specific caps. The researchers will leverage a series of natural experiments induced by the state caps with longitudinal claims data from the Health Care Cost Institute (HCCI) for the period 2011-2015. They will identify the effect of the state policies on spending by leveraging variation: (1) before and after enactment of state caps; (2) across states with and without caps; and (3) across fully-insured and self-insured plans. The analyses will first focus on individuals with rheumatoid arthritis, multiple sclerosis, or hepatitis C and states that instituted a cap during the study period (Delaware, Louisiana, Maine and Vermont). Each intervention state will be compared with adjoining states with similar HCCI coverage that did not enact a cap during the study period. Deliverables will include a project work plan and final narrative and financial reports. The grantee will also produce policy briefs, presentations, blog posts and other social media and paper(s) suitable for publication and present findings at national research meetings and in other forums to stakeholder audiences as appropriate, including policymakers at the federal, state, and local levels and other key stakeholders, as part of the deliverables for this grant.


Patient and Plan Spending after State Specialty-Drug Out-of-Pocket Spending Caps
New England Journal of Medicine | August 2020