Evaluating the impact of specialty pharmacies on access to biologics in patients with moderate-to-severe asthma.

OBJECTIVE

To evaluate whether specialty pharmacy use reduces delays from biologic prescription to insurance approval and administration in patients with moderate-to-severe asthma.

METHODS

We conducted a retrospective cohort study of patients prescribed asthma biologics in the Bronx, New York. Cohorts were defined by time period: before specialty pharmacy implementation (2017-2020) and after (2020-2023). Primary outcomes were time from prescription to insurance approval and administration. Wilcoxon rank-sum tests compared groups, and multivariable regression models adjusted for covariates.

RESULTS

340 patients were included (pre-implementation = 259; post-implementation = 81). Median prescription-to-approval time decreased from six days (IQR 1-20) to two days (IQR 1-8; p = .003). In adjusted analyses, specialty pharmacy use was associated with higher odds of approval within 14 days (OR = 2.67, 95% CI 1.33-5.69, p = .008), though the Cox model was not significant (HR = 1.30, 95% CI 0.95-1.77, p = .10). Median prescription-to-administration time decreased from 34 days (IQR 18-65) to 24 days (IQR 15-36; p = .113). Specialty pharmacy use was not significantly associated with faster administration in Cox models (HR = 1.04, 95% CI 0.73-1.49, p = .82), but showed a borderline association with administration within 30 days in logistic regression (OR = 1.78, 95% CI 0.99-3.27, p = .057).

CONCLUSIONS

Specialty pharmacy implementation significantly accelerated approval and showed a trend toward faster treatment initiation. Delays in administration persisted despite adjustment for patient-level factors, underscoring the role of other barriers. Larger, multi-center studies are warranted.