Prime Therapeutics Study Finds Patients More Likely to Start Specialty Medications When Out-of-Pocket Costs Are Under $250

ST. PAUL, Minn., April 2, 2014 /PRNewswire/ -- Pharmacy plan members with specialty drug out-of-pocket costs (OOP) less than $250 are more likely to start taking their medication than those with higher OOP. This finding is according to a new study presented by Prime Therapeutics LLC (Prime) at the Academy of Managed Care Pharmacy (AMCP) 26th Annual Meeting & Expo in Tampa, Fla.

Increasing member out-of-pocket costs is a common strategy for controlling escalating costs of specialty drugs. These drugs are used to treat complex and chronic conditions and can cost tens of thousands of dollars or more per year. For this study, Prime researchers reviewed claims from members, and identified people newly starting therapy with a biologic anti-inflammatory (BAI) drug, such as those used to treat rheumatoid arthritis, or treatments for multiple sclerosis (MS).

The analysis of members attempting to newly start their MS or BAI therapy found 10.5 percent and 9.8 percent, respectively, had an OOP greater than $1,000 for their first prescription.  Conversely, about two thirds of members starting these treatments had an OOP less than $100.

As costs rise, the study found members are more likely to abandon their new prescription. Abandonment rates became significantly higher for both MS and BAI drugs when OOP reached $250. Additionally, when OOP reached $2,000 or more, the number of members abandoning their new MS prescription was nearly 24 times higher compared to members with OOP less than $100. Similarly, the number abandoning a BAI prescription was more than 19 times higher.

"This analysis indicates costs may be impacting members' ability to initiate these important treatments," said Pat Gleason, PharmD, BCPS, FCCP, director of health outcomes for Prime. "Health insurers should consider these findings when designing pharmacy benefits and keep in mind the members' maximum OOP cost per claim for preferred formulary specialty drugs."

The study reviewed more than 11 million commercial claims, identifying 3,293 members with an MS claim and 12,644 with a BAI claim, between July 1, 2010 and December 31, 2012. 

About Prime Therapeutics

Prime 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 25 million people. It is collectively owned by 13 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. Prime has been recognized by Modern Healthcare as one of "healthcare's hottest companies for 2013."  For more information, visit or follow @Prime_PBM on Twitter.

About Prime Therapeutics Specialty Pharmacy

Prime Therapeutics Specialty Pharmacy LLC is dedicated to making it easier for members to obtain specialty medicines and manage complex conditions. The company offers a full suite of specialty pharmacy services, from care management to insurance billing to delivery of specialty medicines. Based in Orlando, Fla., Prime Therapeutics Specialty Pharmacy LLC is wholly owned by Prime Therapeutics LLC. For more information, visit or follow @Prime_PBM on Twitter.

SOURCE Prime Therapeutics LLC


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