Prime Therapeutics, Johns Hopkins publish research on specialty drug copay coupons in Health Affairs

ST. PAUL, Minn., Oct. 6, 2014 /PRNewswire/ -- Today, the journal Health Affairs published its October issue focused on specialty medicines and included an article on copay coupons authored by researchers at Prime Therapeutics LLC (Prime) and Johns Hopkins Bloomberg School of Public Health.

Specialty medicines are becoming more common as they're used to treat many complex health conditions such as cancer, rheumatoid arthritis and multiple sclerosis. In fact, Prime predicts specialty drug costs will comprise half of total drug spend by 2018.¹ Pharmacy benefit managers like Prime use a number of tools to help members follow their drug therapies and manage the high cost of specialty medicines. Leveraging copay coupons is one way to address the high costs. While coupons for branded medicines when low-cost generics exist ultimately raise costs, specialty drug coupons are different. Most specialty drugs don't have a low-cost generic option available; therefore specialty coupons can be crucial in helping members access the medicines they need. 

"Little has been published on the prevalence and use of copay coupons for specialty medicines, so we're pleased to have our research included in Health Affairs," said Pat Gleason, PharmD, BCPS, FCCP, director of health outcomes at Prime, and one of the article's authors. "Our analyses concluded that coupons, for expensive drugs where no generic option currently exists, can be very important in helping people reduce the cost of medicines and follow their recommended treatment. But coupons may circumvent a health plans' efforts to encourage patients to use the most appropriate, cost-effective drugs and thereby risk increasing health premiums. That's why we recommend only applying coupons to preferred specialty products found on a health plan's formulary or drug list."

Two separate analyses were performed to understand the impact of coupons. First, researchers studied the prevalence of drug coupons and the degree to which they reduced patients' out-of-pocket (OOP) costs.  Among nearly 265,000 specialty prescriptions dispensed by Prime Therapeutics Specialty Pharmacy LLC, they found:

• more than 44 percent of specialty prescriptions had a coupon applied,
• coupons covered more than 60 percent of members' OOP costs, totaling $21.2 million, and
• average yearly savings per member equaled $1,069 during 2013.

Second, researchers examined the association between high OOP costs and non-adherence (abandoning new or restarted therapy) among nearly 16,000 members. These members newly started or restarted a biologic anti-inflammatory specialty drug or multiple sclerosis drug, the two drug classes with the highest number of specialty prescriptions. Findings included:

• for biologic anti-inflammatory drugs, only 5.2 percent of members with monthly OOP less than $50 abandoned their therapy; however, when monthly OOP totaled $2,000 or more 52 percent abandoned their therapy.
• similarly, for multiple sclerosis drugs, only 6.1 percent of members with monthly OOP less than $50 abandoned their therapy; but when monthly OOP totaled $2,000 or more abandonment climbed to 60 percent.

Peter Wickersham, Prime's senior vice president of integrated care and specialty, noted "As more specialty medicines come to market and put added strain on our health care dollars, it's important to understand the associations of cost sharing on adherence, the prevalence of coupon use, and when it's appropriate to apply them. It's our hope that this insight will increase transparency about coupons and help bring manufacturers, payers  and policymakers together as they examine how to ensure patient access and control soaring drug prices."

 A complete copy of the Health Affairs article is available on our Industry Insights blog.

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 www.primetherapeutics.com  or follow @Prime_PBM on Twitter.

¹   Prime Therapeutics. "Looking Back Looking Forward: 2014 Report on Prescription Drug Costs [Internet]. Eagan (MN): Prime Therapeutics; [cited 2014 Sept. 25]. Available from:  http://bit.ly/TteYzb

SOURCE Prime Therapeutics