Prime Therapeutics study shows wide variation in hemophilia treatment costs

Integration of medical and pharmacy data shows pharmacy benefit preferred for clotting factor management

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Oct 11, 2013, 09:00 ET

ST. PAUL, Minn., Oct. 11, 2013 /PRNewswire/ -- Treatment costs for the congenital bleeding disorders, hemophilia and von Willebrand's Disease (vWD) can vary substantially, from as little as $1,139 per year to more than $3 million per year, according to a study by pharmacy benefit manager Prime Therapeutics LLC (Prime). Prime will be presenting the study at the Academy of Managed Care Pharmacy (AMCP)'s Nexus 2013 conference in San Antonio on Oct. 17, 2013.

For individuals with bleeding disorders, clotting factor replacement therapies are an essential treatment to help blood clot normally. However, over the life-time of someone with hemophilia, as many as one-third of patients may develop an antibody – called an inhibitor – that causes their body to view the clotting factor as a foreign substance and try to destroy it. These patients may be treated with increasing doses of clotting medications, through drugs called bypassing products or anti-inhibitor complex, or through efforts to increase immune system tolerance of clotting medications.

To support better disease management and cost control strategies for these individuals and understand reasons for wide cost variations, Prime evaluated 2012 medical and pharmacy claims data for 10 million commercially insured members in 11 health plans. The Prime health outcomes team identified the prevalence of clotting factor treatments and individual cost variables.

The analysis found 382 members (5 per 100,000) were treated for hemophilia or vWD, and the total cost for clotting factor treatments was $80.6 million. There was a significantly higher prevalence of the treatment being used for members younger than 25, versus those age 25 to 64. Individual costs for clotting factor treatments also ranged significantly, from $1,139 to $3,141,470 annually per member. More than 5 percent were treated with a bypassing product and these were the highest cost members.

Clotting factor utilization analyzed in the medical data was substantially less accurate than that analyzed in the pharmacy benefit. Pharmacy benefit data have the advantages of real-time claims adjudication and requirements for more specific drug information.

"Cost variation among hemophilia and vWD treatments can be attributed to the member's diagnosis, age and use of bypassing products," said Pat Gleason, PharmD, BCPS, FCCP, director of health outcomes for Prime. "To better manage the use of clotting factor treatments, health plans should consider shifting clotting factor coverage to the pharmacy benefit and assess body weight, the disease severity, the treatment protocol, and member adherence to treatment."

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 nearly 23 million people. It is collectively owned by 13 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. Prime has been recognized as one of the fastest-growing private companies in the nation.

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