Prime Data Suggest Specialty Drugs for HCV, RA Fail to Produce Savings

Prime Therapeutics' new studies, scheduled to be presented at AMCP, reveal that expected medical savings from the utilization of specialty drugs no longer offset the high cost of these therapies for the treatment of hepatitis C and rheumatoid arthritis.

Prime Therapeutics’ new studies, scheduled to be presented at AMCP, reveal that expected medical savings from the utilization of specialty drugs no longer offset the high cost of these therapies for the treatment of hepatitis C and rheumatoid arthritis.

New data from Prime Therapeutics set to be presented today at the Academy of Managed Care Pharmacy’s 25th Annual Meeting & Expo in San Diego, California, reveal troubling findings about the cost of specialty drugs. Contrary to expectations, the data indicate that proper patient adherence to high-cost medications does not produce significant medical savings overall.

In 2 separate studies, Prime researchers at the pharmacy benefit manager (PBM) examined medical claims from 1.2 million members who received a specialty drug for the treatment of hepatitis C (HCV) or rheumatoid arthritis (RA). Total cost of care for each patient was measured and broken down by medical specialty drug, medical “all other,” pharmacy specialty drug, and pharmacy “all other.”

The researchers found that specialty drug costs accounted for approximately 50% of the total cost of care for both HCV and RA. In 2011, specialty drugs for HCV accounted for nearly 53% ($18,098 of $34,163) of the total cost of care, up from nearly 35% ($13,332 of $38,055) in 2008. For RA, the portion of total cost of care accounted for by specialty drugs remained fairly steady from 2008 to 2011 (declining slightly from nearly 55% to 53%). However, the total cost of care compounded annual growth rate increased 7.3% from 2008 to 2011.

Many experts have predicted that 50% of all drug expenditures will be for specialty therapies by 2030, but Prime estimates that this threshold will be reached by 2018.

The researchers also concluded that the specialty category containing the top expenditure drug on both the pharmacy and medical benefits is the autoimmune group, which is consistent with Express Scripts’ recent findings.

To get a handle on this increasing specialty spend, “Health insurers will need to increase their vigilance of specialty drugs and focus on 4 management opportunities: drug distribution channel, utilization management, contracting activities, and coordination of care,” concluded the study authors.

From Prime Therapeutics' poster, "Specialty Drugs are Forecasted to be 50 Percent of All Drug Expenditures in 2018."

We spoke to one of the study authors, Patrick Gleason, PharmD, BCPS, FCCP, director of health outcomes at Prime Therapeutics, at PBMI’s 2012 Drug Benefit Conference about some of the utilization management techniques that health plans and PBMs can use to control specialty spend. He revealed at this conference that there may be a shift in the revenue model for injectables and infusibles in the future. To learn more, watch the video below: