EAGAN, Minn., April 16, 2020 /PRNewswire/ -- New research from Prime Therapeutics LLC (Prime), a pharmacy benefit manager (PBM) serving more than 30 million members nationally, found that among commercially insured members with asthma, the number of members who utilized biologics nearly doubled in a 2.5 year span, as did the amount of spending on those medications.
According to the U.S. Centers for Disease Control (CDC), asthma affects more than 25 million Americans with an estimated societal cost of $82 billion.1,2 Biologic medicines are indicated for the treatment of severe asthma, which affects 5-10% of those with asthma but accounts for nearly 50% of total asthma costs.3
For the study, Prime analyzed pharmacy and medical claims of 14 million commercially insured members from January 2017 to June 2019, including the medicines: Cinqair® (reslizumab), Dupixent® (dupilumab), Fasenra® (benralizumab), Nucala® (mepolizumab), and Xolair®(omalizumab). During the study period, the number of members with an asthma diagnosis using an asthma biologic increased by 78%, from 3.3 to 5.8 users per 10,000 members. This correlated with a cost increase of 85%, from $0.45 to $0.84 per member per month.
A separate analysis evaluated persistence and total cost of care in members new to asthma biologic therapy from July 2017 to December 2018, among the same population. There were 1,492 members who fit the new initiator criteria of having an asthma diagnosis, being new to one of four asthma biologic medicines (dupilumab excluded), and being continuously enrolled six months before and after the first asthma biologic claim. Persistence – receiving therapy in accordance with prescribing information – was low among members with 48.5% of asthma biologic new initiators not receiving all doses during the first six months following therapy start. Even with low persistence, the total cost of care for members new to asthma therapy increased 2.6-fold, due to the high asthma biologic cost, when comparing six months before and after their first asthma biologic claim.
"The expensive asthma biologics are quickly growing in utilization and cost with little known about the real-world patient persistence and value they bring. This study indicates low persistence and substantial asthma biologic therapy cost," said Catherine Starner, PharmD, BCPS, health outcomes consultant senior principal for Prime. "Therefore, it is important to have a better understanding of asthma biologic use patterns, cost-effectiveness, and to implement pharmaceutical manufacturer value-based contracts."
According to the Institute for Clinical and Economic Review's (ICER) 2018 final report on asthma biologics, all five asthma biologics exceeded thresholds for cost-effectiveness. For a $100,000 investment per quality adjusted life year gained, fair value price was found to be between $6,500 and $10,100 annually depending on the drug – which is 73-80% lower than the current list prices.
Prime's real-world data, combined with ICER's report, indicates insurers should consider implementing value-based agreements on asthma drugs to help lower costs and develop clinical programs to improve use of medicines as prescribed.
This research will be presented at the Academy of Managed Care Pharmacy (AMCP) 2020 virtual learning event April 20-24.
- Centers for Disease Control and Prevention. Most Recent National Asthma Data. Page last reviewed: March 2020; https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm. Accessed March 2020.
- Nurmagambetov T, Kuwahara R, Garbe P. The Economic Burden of Asthma in the United States, 2008-2013. Ann Am Thorac Soc. 2018 Mar;15(3):348-356.
- Institute for Clinical and Economic Review. Biologic therapies for treatment of asthma associated with type 2 inflammation: effectiveness, value, and value-based price benchmarks. Final Evidence Report. December 20, 2018.
About Prime Therapeutics
Prime Therapeutics LLC (Prime) makes health care work better by helping people get the medicine they need to feel better and live well. Prime provides total drug management solutions 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 30 million people. For more information, visit www.primetherapeutics.com or follow @Prime_PBM on Twitter.
SOURCE Prime Therapeutics LLC