Autoimmune Specialty Drug Spending Doubled in 4 Years

In the past 4 years, spending on specialty drugs for autoimmune conditions doubled among the 4.4 million commercially-insured members of Prime Therapeutics.

The pharmacy benefit manager also found that utilization of these drugs increased nearly 40% during this time. Other studies also discovered a large increase in spending on specialty drugs, some finding that spending tripled since 2003.

Researchers in the current study used integrated medical and pharmacy data to determine the prevalence of the drugs. According to Prime Therapeutics, the use of integrated data is crucial for these drugs, since a large portion are covered by medical benefits, and medical claims diagnosis coding regulates the conditions treated with drugs covered by pharmacy claims.

There are currently 15 specialty autoimmune drugs, and the class is continuing to grow. There were 3 specialty autoimmune drugs approved within the study period (2012 to 2015), and a fourth gained approval in 2016.

In the study, researchers at Prime investigated medical and pharmacy data regarding Crohn’s disease, ulcerative colitis, psoriasis, psoriatic arthritis, ankylosing spondylitis, juvenile idiopathic arthritis, and rheumatoid arthritis.

Of the 4.4 million patients included in the study, Prime discovered that 0.6% used 1 or more autoimmune specialty drugs. They also found that the number of members using these drugs increased 38.8% during the study period, and total payments increased 102.7%.

Specialty autoimmune drugs accounted for 1 of every $10 of drug expenses through the medical and pharmacy benefits in 2015, according to Prime. Certain drugs in this class can treat multiple autoimmune diseases, such as Humira, which is indicated for all 7 autoimmune disorders; however, some treatments only have 1 indication.

“This overlap and diversity presents an opportunity for health plans to encourage the most cost effective treatments through an indication-based formulary and utilization management programs,” said Kevin Bowen, MD, MBA, principal health outcomes researcher at Prime. “This research and Prime’s integration capabilities provide the detail for a discussion with drugmakers about indication-based pricing that may also help reduce overall health care costs.”