Prime Therapeutics Research Finds Nearly Half of Members Discontinue Costly RA Drug After One Year

ST. PAUL, MINN. – Sept. 27, 2016 – Prime Therapeutics LLC (Prime), a pharmacy benefit manager serving over 22 million members nationally, analyzed members’ use of rheumatoid arthritis (RA) drug tofacitinib (Xeljanz®) to find patterns and adherence behaviors. While use of the drug had been low (one member per 100,000 commercially insured members per month shortly after approval) it is steadily increasing. The study found that potentially 1 in 10 members did not follow guidelines to use Xeljanz as a second line therapy and 44 percent had discontinued the drug at one year after starting therapy. This research will be presented at the Academy of Managed Care Pharmacy (AMCP) Nexus event Oct. 3-6 in National Harbor, Md.

Prime analyzed 4.4 million commercially insured members who were continuously enrolled over a four year period – from December 2012 to December 2015. Of those members, 887 used Xeljanz during that time period and 97.2 percent of those members had a medical claim indicating an RA diagnosis. On average, use of Xeljanz increased steadily by 10.5 members per month throughout the analysis period.

“Although utilization of Xeljanz is low, it is steadily increasing,” said Pat Gleason, PharmD, director of health outcomes at Prime. “With a lack of long-term safety and efficacy information and a wholesale acquisition cost (WAC) of over $42,000 per year, it is critical to understand real world Xeljanz utilization patterns to best manage the health of our members with rheumatoid arthritis.”

Xeljanz is identified in the American College of Rheumatology Guidelines as a second line therapy option in patients with RA. However, one in 10 members were using it as first line therapy and did not have a disease-modifying anti-rheumatic drug (DMARD) claim in the year prior to Xeljanz therapy, in accordance with the guidelines.

At one-year follow-up, 44 percent of members had discontinued Xeljanz and over 30 percent had discontinued at six months. This discontinuation rate is concerning, especially since RA is a chronic disease generally requiring life-long therapy.

“Prime’s research on utilization and adherence patterns of the rheumatoid arthritis drug Xeljanz shows there is opportunity for improvement,” added Gleason. “Care and utilization management programs, as well as outcomes-based contracts with pharmaceutical manufacturers, that encourage adherence and the most cost effective treatment strategies, should be considered. These programs should emphasize the use of a nonbiologic DMARD as first line therapy.”

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.

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