Prime Therapeutics Finds Autoimmune Specialty Drug Spend has Doubled

ST. PAUL, MINN. – Sept. 30, 2016 –In the past four years, spending on autoimmune drugs has doubled and utilization has jumped nearly 40 percent in a population of 4.4 million commercially-insured members, according to new research from Prime Therapeutics LLC (Prime), a pharmacy benefit manager serving more than 22 million members nationally.

This research, studying the prevalence of use and cost of autoimmune specialty drugs using integrated medical and pharmacy data, will be presented at the Academy of Managed Care Pharmacy (AMCP) Nexus event Oct. 3-6 in National Harbor, Md. Integrated data is essential for this drug category because a significant percent of expense for these drugs is covered by medical benefits, and medical claims diagnosis coding determines what conditions were treated with drugs covered by pharmacy claims.

The autoimmune drug class is one of the fastest growing classes. There are now 15 specialty autoimmune drugs along with many traditional generic drugs to treat autoimmune conditions such as Crohn’s disease, ulcerative colitis, psoriasis, psoriatic arthritis, ankylosing spondylitis, juvenile idiopathic arthritis and rheumatoid arthritis. During the 2012 to 2015 study period, the Food and Drug Administration (FDA) approved three new specialty autoimmune drugs, with a fourth approved in March 2016.

Among 4.4 million commercially-insured members who were continuously enrolled from 2012 to 2015, 0.6 percent used at least one autoimmune specialty drug. The number of members using any of these drugs in a year increased 38.8 percent from 2012 to 2015, yet total payments increased 102.7 percent. In 2015 these drugs accounted for about one in every 10 dollars of combined drug expense through the medical and pharmacy benefits. Drug payments for each condition by year from 2012 to 2015 are available on the poster.

Several specialty drugs are used to treat multiple conditions within the autoimmune class. For example, Humira® is indicated for all seven conditions represented in this study while other drugs may have an indication for only one condition. “This overlap and diversity presents an opportunity for health plans to encourage the most cost effective treatments through an indication-based formulary and utilization management programs,” said Kevin Bowen, M.D., M.B.A., principal health outcomes researcher at Prime. “This research and Prime’s integration capabilities provide the detail for a discussion with drugmakers about indication-based pricing that may also help reduce overall health care costs.”

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 just over 22 million people. It is collectively owned by 14 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans.

For more information, visit  or follow @Prime_PBM on Twitter.

Check Also

MEI Pharma and Helsinn Group Discontinue Phase 3 Study of Pracinostat in AML After Interim Analysis

Lugano, Switzerland and San Diego, USA, July 2, 2020 – Helsinn, a Swiss pharmaceutical group focused …