Prime Therapeutics Study Reveals Botox® is Highest Cost Therapy to Treat Certain Neurologic Conditions

Real-world use shows over $6 million savings potential switching from Botox® to lower cost therapies

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Sep 23, 2019, 09:00 ET

EAGAN, Minn., Sept. 23, 2019 /PRNewswire/ -- Health outcomes researchers at pharmacy benefit manager (PBM) Prime Therapeutics LLC (Prime) analyzed real-world use of the botulinum toxin (BT) Botox® (Onabotulinumtoxin A) and three other BTs approved to treat several movement disorders and found shifting treatments from Botox® to the equally effective, lower cost BT therapies would save an estimated $6.3 million annually.

By employing a total drug management approach, Prime's holistic strategy is designed to manage both medical and pharmacy drug therapies to achieve optimal member health outcomes at the lowest possible net cost. Prescription medications dispensed by medical providers, such as in a hospital or doctor's office, accounted for approximately 27% of new Food and Drug Administration (FDA) approvals in 2018. BTs are covered on the medical benefit as they are administered by a provider in a clinic.

Botox® has many approved uses and is one medicine that requires expertise in medical drug claim analytics to assess its appropriate use. Prime's health outcomes researchers have this expertise. As such, Prime analyzed health care claims from 15 million commercially insured members and found 58,000 BT claims totaling more than $76 million in 2018. BT drug claims to treat three movement disorders – cervical dystonia (CD), limb spasticity (LS) and blepharospasm (BS) – accounted for more than 32% of total BT spend, while 60% of the spend was for migraine treatments. Botox® accounted for about 90% of BT spend and was the highest cost treatment for the three conditions studied.

Looking at real-world member use and cost, Prime discovered one BT prescribed for members with CD (Abobotulinumtoxin A) had a 33% lower cost than Botox®. Another BT used to treat members with LS and BS (Incobotulinumtoxin A), cost 26% and 29% less, respectively, than Botox®. Consequently, shifting to the lowest cost therapy for the three conditions would result in approximately $6.3 million in health plan savings annually.

Analysis of the time between doses for all types of BT treatments showed no difference; therefore, a switch to preferring one BT over another should not increase treatment frequency. Thus, switching BT type is highly unlikely to change the annual number of office visits members require for BT administration.

"It's crucial to understand the real-world use of medical-side drugs to illustrate how shifting to lower cost equivalent therapies can produce similar results for a member, and better cost effectiveness," said Patrick Gleason, assistant vice president, health outcomes for Prime. "Our industry-leading total drug management approach is essential to transforming health care."

Botox® was the first BT therapy approved to treat neurologic disorders including CD, LS and BS. People with these conditions experience involuntary muscle contractions. Botox® works by blocking the neurotransmitter release from nerve endings to muscle, allowing the muscle to temporarily relax. As a result, abnormal movements or muscle contractions may be decreased.

Prime researchers will present this study at the Academy of Managed Care Pharmacy's (AMCP) Managed Care & Specialty Pharmacy Nexus Meeting Oct. 29 – Nov. 1 in National Harbor, Md.

About Prime Therapeutics
Prime Therapeutics LLC (Prime) makes health care work better by helping people get the medicine
hey 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 28 million people. It is collectively owned by 18 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. For more information visit www.primetherapeutics.com or follow @Prime_PBM on Twitter.