Specialty drugs in ambulatory care visits: National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, United States, 2009-2010

Although specialty drugs provide groundbreaking treatment options for different complex, chronic, and sometimes rare conditions, they are among the most expensive drugs due in part to special handling, delivery, and administration requirements. This study describes the occurrence of specialty drugs included in ambulatory care visits to physician offices and hospital outpatient departments. Data were from the 2009-2010 National Ambulatory Medical Care Survey (n=67,541 physician office visits) and National Hospital Ambulatory Medical Care Survey (n=68,269 outpatient visits). Medication data included up to eight prescription and over-the-counter drugs that were ordered, supplied, administered, or continued during the visit. Specialty drugs were defined using Express Scripts and CVS Caremark specialty-drug formularies. Overall, 2.7% of physician office visits (~28.0 million) and 4.8% of outpatient visits (~4.7 million) included specialty drugs. Among office visits, 11.9% with a cancer diagnosis, 10.1% with osteoporosis, and 8.5% with chronic renal failure included specialty drugs, compared to 19.4%, 10.6%, and 13.4%, respectively, in outpatient visits.  Multivariate analysis found that both office and outpatient visits with specialty drugs were more likely to happen among Medicare patients; patients with cancer, chronic renal failure, arthritis, and osteoporosis; and patients seen by a nurse. Physician office visits to medical specialists were more likely to include specialty drugs than visits to primary care providers.  Outpatient visits with specialty drugs were less likely to occur in micropolitan areas.  In summary, physician office and outpatient visits with specialty drugs in the United States varied by practice and visit characteristics.