ST. PAUL, Minn., April 20, 2018 /PRNewswire/ -- An analysis of real-world, integrated pharmacy and medical claims by pharmacy benefit manager (PBM) Prime Therapeutics LLC (Prime) reveals the cost of coagulation factor products to treat hemophilia more than doubled for members who switched from standard half-life (SHL) to extended half-life (EHL) products. Prime researchers will present the study at the Academy of Managed Care Pharmacy's (AMCP) Managed Care & Specialty Pharmacy 30th Annual Meeting April 23-26 in Boston.
Conventional SHL coagulation (clotting) drugs prevent bleeding and are dosed two to three times per week. EHL therapies are designed to keep clotting factor circulating in the body longer, stretching the time between infusions and decreasing risk for bleeding. Based on the findings of this study, if the 80 percent of Prime's members with hemophilia A who are currently using SHL products switched to new EHL products, costs for health plans and its members could increase by more than $130 million per year. Therefore, PBMs and health plans need to closely assess EHL clinical value and cost effectiveness.
Hemophilia is a severe bleeding disorder resulting from the lack of an essential clotting protein (factor). While it only affects approximately 20,000 Americans, hemophilia demands a disproportionate share of health care dollars, primarily because the per person specialty drug therapy costs far exceed the pharmacy spending in many other chronic disease conditions.
Individuals with hemophilia A have a Factor VIII deficiency and make up about 80 percent of individuals with hemophilia, while those with hemophilia B are marked by a Factor IX deficiency, and comprise the remaining 20 percent. Clotting factor is prescribed to treat hemophilia in the form of coagulation factor products.
For the study, Prime analyzed integrated pharmacy and medical claims data for an average of 15 million commercially insured members per month from January 2013 to July 2017 to identify all hemophilia A and B members with claims for a factor product. Thirty-four hemophilia A and 20 hemophilia B members who switched from SHL to EHL therapy met the study requirement of continuous enrollment. And of these 54 members both pre- and post-switch costs were analyzed to calculate the impact of switching on both factor cost and amount of drug units used.
For the 34 members with hemophilia A, mean cost for SHL was $127,168 per six months compared with $300,429 (2.36 times higher) for EHL. Mean units per six months was 33 percent higher for EHL than SHL. For the 20 members with hemophilia B, mean cost for SHL was $116,909 per six months compared with $230,210 (1.97 times higher) for EHL. Mean units per six months was 14.9 percent lower for EHL than SHL for hemophilia B. None of the 54 members who switched therapies had claims that could be identified as indicating a bleeding event before or after the switch.
If the 80 percent of hemophilia A members currently using SHL switched to EHL, costs could potentially increase by more than $130 million, or more than $0.70 per member per month (PMPM).
"This analysis of real-world claims data found that switching to EHL products often did not reduce the number of factor units members used. The frequent use of more factor units after the switch to an EHL product and much higher per unit cost of EHL products led to substantially higher costs for hemophilia treatment," said Kevin Bowen, M.D., principal health outcomes researcher at Prime. "Use of EHL products has led to substantial increases in the cost of hemophilia treatment in this commercially insured population that need to be justified clinically."
To help manage hemophilia, Prime employs a utilization management strategy designed to appropriately manage EHL products. Prime's rigorous formulary development process provides clients and their members with formularies that are clinically complete and cost effective to help manage high specialty drug costs associated with chronic and rare conditions such as hemophilia.
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 offers clinical services for people with complex medical conditions. Prime serves more than 27 million people. It is collectively owned by 18 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. For more information, visit www.primetherapeutics.com or follow @Prime_PBM on Twitter.
SOURCE Prime Therapeutics