# Pharmacy Dispensing Channel and Specialty Drug Adherence and Outcomes among Medicare Beneficiaries

> **NIH NIH R21** · UNIVERSITY OF PENNSYLVANIA · 2021 · $140,512

## Abstract

PROJECT SUMMARY
Specialty drugs are innovative, high-cost therapies used to treat complex, chronic conditions such as cancer,
rheumatoid arthritis (RA), and multiple sclerosis (MS). Despite the medical advances offered by these
medications, studies have shown that adherence to specialty drugs is suboptimal; the negative outcomes
associated with poor adherence are also well documented. Given that patients often experience adherence
barriers and require extra support to reap the full benefits of treatment, specialty pharmacies—specialized
distribution channels to handle specialty drug treatment—have quickly emerged as a valuable tool to improve
adherence to specialty drugs. The support services offered by these pharmacies (e.g., identifying financial
assistance, offering extra patient education) hold particular promise for Medicare beneficiaries, who often face
unique circumstances that make adherence a greater challenge. Despite the potentially helpful services
offered by specialty pharmacies, available evidence suggests that most Medicare beneficiaries continue to fill
their specialty drugs at regular retail pharmacies. Further, studies till date on adherence improvements
associated with specialty pharmacy use are limited in both methodology and generalizability to the Medicare
population. Empirical evidence on the use of specialty pharmacy by Medicare beneficiaries and the impact on
medication adherence is needed. Thus, the aims of this study are (1) to examine trends and geographic
variations in the use of specialty pharmacy as the dispensing channel for specialty drugs among Medicare
beneficiaries from 2013 to 2017; (2) to determine the impact of specialty pharmacy use on adherence and
treatment gaps among Medicare beneficiaries newly initiating a specialty drug, using an instrumental variable
analysis that allows for “causal” inference; and (3) to determine the impact of specialty pharmacy use on
outcomes among Medicare beneficiaries newly initiating a specialty drug. This study will be the first to use
national Medicare claims data and instrumental variable analysis to address these research questions in
Medicare patients initiating specialty drugs for chronic myeloid leukemia, chronic lymphocytic leukemia,
rheumatoid arthritis, and multiple sclerosis. Our study will offer robust evidence on the effectiveness of
specialty pharmacies at improving adherence and outcomes in the Medicare population and identify patient
subgroups most likely to benefit from use of such pharmacies. Strong empirical evidence on the benefit of
specialty pharmacies for Medicare beneficiaries may spur policymakers to reassess the Any Willing Pharmacy
(AWP) provision under Medicare Part D, which may inadvertently drive the high rates of retail pharmacy use
for specialty drug fills in this population. Finally, the results of our study will guide subsequent R series grants
to identify specific specialty pharmacy types and/or support services that are most effective, with...

## Key facts

- **NIH application ID:** 10218362
- **Project number:** 1R21AG068726-01A1
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Jalpa A. Doshi
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $140,512
- **Award type:** 1
- **Project period:** 2021-05-01 → 2023-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10218362

## Citation

> US National Institutes of Health, RePORTER application 10218362, Pharmacy Dispensing Channel and Specialty Drug Adherence and Outcomes among Medicare Beneficiaries (1R21AG068726-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10218362. Licensed CC0.

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