Specialty drug costs account for more than 50 percent of the total cost of care for rheumatoid arthritis and hepatitis C patients

April 2, 2013, 9:00 a.m. EDT
Specialty drug costs account for more than 50 percent of the total cost of care for rheumatoid arthritis and hepatitis C patients

Studies suggest need for development of specialty medication management programs to manage the increasing burden of specialty drug costs

SAN DIEGO, April 2, 2013 /PRNewswire via COMTEX/ -- According to two new studies by Prime Therapeutics (Prime), a leading pharmacy benefit manager, rheumatoid arthritis (RA) and hepatitis C (Hep C) specialty drug costs now make up more than half of the total cost of care for patients with these conditions. Prime will present these studies at the Academy of Managed Care Pharmacy (AMCP)'s 25th Annual Meeting & Expo in San Diego.

"As the pipeline of expensive specialty drugs continues to grow, we need to stay alert to cost of care trends to make sure patients and plan sponsors receive the best value and can manage the increasing cost burden these treatments bring," said Patrick Gleason, PharmD, FCCP, BCPS, director of health outcomes at Prime.

The two studies from Prime, in conjunction with Blue Cross and Blue Shield of Minnesota, evaluated RA and Hep C cost of care trends.

In the first study, researchers found that despite the overall decrease in Hep C specialty drug use from 2008 to 2011 (17.2 percent vs. 14.1 percent), the Hep C specialty pharmacy total cost of care compound annual growth rate (CAGR) was 15 percent from 2008 to 2011. Specialty drug costs accounted for 35 percent ($13,332 of $38,055) of the total cost of Hep C care in 2008 and was substantially higher at 52.6 percent in 2011 ($30,415 of $57,799), with a CAGR of 31.8 percent.

In the second study, researchers found that although RA drug use remained steady from 2008 to 2010 (34.6 percent vs. 35.4 percent), the total cost of care CAGR was 7.3 percent from 2008 to 2010. All other medical costs were $11,252 in 2008 and increased to $13,710 in 2010, with a CAGR of 10.4 percent. Combined RA medical and specialty drug costs accounted for $16,218 (54.7 percent) of $29,652 total cost of care in 2008. In 2010, total cost of care was slightly lower at 53.0 percent ($18,098 of $34,163), with a CAGR of 5.6 percent.

"These studies show the RA and Hep C pharmacy costs now go beyond all medical costs, therefore the expected medical savings cannot offset the specialty drug investment," said Gleason. "As pharmacy benefit managers and health plans strive work to improve the quality of care for individuals with specialty drug needs, the expected increases in cost of care can be lessened through specialty pharmacy management programs. These programs include care management, a limited specialty network, utilization management, and rebate contractual relationships that provide price inflation protection."

Both studies analyzed integrated pharmacy and medical claims from 1.2 million commercially insured, continuously enrolled members receiving a Hep C or RA specialty drug. Among members using these drugs, the average per patient, per year total cost of care was calculated and total cost of care was separated by the following categories: medical specialty drug, medical all other, pharmacy specialty drug and pharmacy all other.

About Blue Cross and Blue Shield of Minnesota Blue Cross and Blue Shield of Minnesota, with headquarters in the St. Paul suburb of Eagan, was chartered in 1933 as Minnesota's first health plan and continues to carry out its charter mission today as a health company: to promote a wider, more economical and timely availability of health services for the people of Minnesota. Blue Cross is a not-for-profit, taxable organization. Blue Cross and Blue Shield of Minnesota is an independent licensee of the Blue Cross and Blue Shield Association, headquartered in Chicago. Go to bluecrossmn.com to learn more about Blue Cross and Blue Shield of Minnesota.

The Blue Cross and Blue Shield Association is a national federation of 38 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for 100 million members - one-in-three Americans. For more information on the Blue Cross and Blue Shield Association and its member companies, please visit www.BCBS.com. We encourage you to connect with us on Facebook, check out our videos on YouTube, follow us on Twitter and check out The BCBS Blog, for up-to-date information about BCBSA

About Prime TherapeuticsPrime Therapeutics LLC (Prime) helps people get the medicine they need to feel better and live well. Prime manages pharmacy benefits for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and delivers medicine to members, offering clinical services for people with complex medical conditions. Headquartered in St. Paul, Minn., Prime serves nearly 20 million people. It is collectively owned by 13 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. Prime has been recognized as one of the fastest-growing private companies in the nation.

SOURCE Prime Therapeutics

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