Autoimmune Specialty Drug Spending Doubles, Accounting for 10 Percent of Drug Expenses Interview with:

Kevin Bowen MD MBA Senior Health Outcomes Researcher Prime Therapeutics LLC 1305 Corporate Center Drive Eagan, MN 55121

Dr. Kevin Bowen

Kevin Bowen MD MBA
Senior Health Outcomes Researcher
Prime Therapeutics LLC
1305 Corporate Center Drive
Eagan, MN 55121 What is the background for this study? What are the main findings?

• Autoimmune specialty drugs now account for about one of every 10 dollars of combined drug expense through the medical and pharmacy benefits in a commercially insured population.
• The autoimmune drug class is one of the fastest growing, with this study finding a doubling in autoimmune drug expenditures and a 38 percent increase in utilization, in the most recent four years.
• Integrated analysis of medical and pharmacy claims is essential for this category of drugs because more than 25 percent of autoimmune specialty drug use is paid through the medical benefit and medical claims diagnosis coding provides a means of determining what conditions were treated with drugs covered by pharmacy claims. What should readers take away from your report?

• With over 15 autoimmune drugs, it is essential for payers and insurers to focus utilization and cost management on this rapidly increasing drug class.
• Medical claim provider information and diagnosis coding can also be used to categorize autoimmune drug use by indication, which may be helpful in designing strategies to manage cost effective use and for indication-based pricing. What recommendations do you have for future research as a result of this study?

• The medical and pharmacy claims integrated methodology developed for this study should permit rapid analysis of changes in utilization of autoimmune specialty drugs by indication.
•This research provides foundational data to forecast future expenditures and utilization trends by autoimmune drug treated condition. In addition, it provides an understanding of the autoimmune site of administration, for example doctor office, medical benefit billed drug, or self injected, pharmacy benefit billed drug allowing for future research and cost savings assessments.
• Future research can explore the effects of new drugs, such as the entry of the recently approved biosimilar products, and managed care strategies, on total patterns of utilization by indication and other variables such as site of service and specialty of prescriber (pharmacy claims) or servicing provider (medical claims). Is there anything else you would like to add?

• The demand for drugs to treat this condition is anticipated to continue to grow as additional treatment options become available.
• The good news for patients and health plans is that competition among drugs with the same indications may provide pharmacy benefit managers with new means of negotiating better prices and encourage use of the most cost-effective therapies. Thank you for your contribution to the community.

Citation: Abstract presented at the Academy of Managed Care Pharmacy (AMCP) Nexus event
Oct. 3-6 in National Harbor, Md.

Prevalence and Cost of Autoimmune Specialty Drug Use by Indication in a 4.4 Million Member Commercially Insured Population Continuously Enrolled Four Years, 2012 to 2015
K. Bowen, MD, MBA1 , P.P. Gleason, PharmD,1,2 1Prime Therapeutics LLC, Eagan, MN, United States; 2University of Minnesota, College of Pharmacy, Minneapolis, MN, United States

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on October 4, 2016 by Marie Benz MD FAAD