Studies show increasing costs and potential for significantly higher use of specialty drugs to treat inflammatory autoimmune conditions

Three new studies review use, comparative effectiveness and cost

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Apr 04, 2013, 09:00 ET

SAN DIEGO, April 4, 2013 /PRNewswire/ -- In recent years, biologic anti-inflammatory (BAI) specialty medications used to treat autoimmune inflammatory conditions such as rheumatoid arthritis (RA), psoriasis and Crohn's disease, have seen double-digit percentage price increases. The potential exists to treat many more patients than are currently receiving a BAI medication, according to new studies presented today by pharmacy benefit manager Prime Therapeutics. Presented at the Academy of Managed Care Pharmacy (AMCP)'s 25^th Annual Meeting & Expo in San Diego, the studies describe trends in use by disease and drug. The research also compares duration of use of the top three drugs (which may reflect differences in effectiveness), and analyzes dose changes for the top two drugs. All of these findings are critical to management of this key driver of heath care costs.

BAI utilization patterns and management opportunities

In the first study, Prime researchers studied a sample of 2.6 million members who were continuously insured for three years in order to determine how many were diagnosed with the diseases for which BAI treatment is approved. The study also looked at how many of these members were treated with a BAI drug, and how much newly started treatment, by disease and medication. The diseases studied included rheumatoid arthritis (RA), psoriasis, Crohn's disease, ulcerative colitis, ankylosing spondylitis, and juvenile idiopathic arthritis.

From Jan. 1, 2009, to Dec. 31, 2011, 39,848 members in the study had medical claims that showed an autoimmune disease for which a BAI drug could have been used. Use of BAIs during that time period increased 29.4 percent, with the greatest increase in use among adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade). However, just 10,769 members had a BAI claim, representing just slightly more than one in four members with a diagnosis for which a BAI could be used.

"There are a significant number of patients who could be treated with these drugs, who are not currently receiving them," said Patrick Gleason, PharmD, FCCP, BCPS, director of health outcomes at Prime. "Health plans need to prepare for the possibility that use of these costly drugs could increase considerably in coming years."

TNF medication effectiveness in adult Crohn's, RA patients

In this study, Prime researchers studied how long members continue treatment with the three most common BAI drugs to explore comparative effectiveness. This study included all members with new treatment starts for (adult) Crohn's disease or rheumatoid arthritis in 2010 or 2011.

The analysis included 1,003 patients newly starting treatment for Crohn's disease, of whom 494 were prescribed infliximab (Remicade®) and 509 were prescribed adalimumab (Humira®). Length of treatment was significantly shorter for patients taking infliximab, with 25 percent stopping treatment by four months and 50 percent by 16 months, compared to six months and 22 months for those treated with adalimumab.

The study also included 2,821 patients with new treatment starts for RA, of whom 284 were prescribed infliximab, 1,301 adalimumab, and 1,236 etanercept (Enbrel®). Researchers found no major difference in the time to discontinuation among these three medications, with 25 percent discontinuation at less than four months for all three drugs, and 50 percent discontinuation for each at 13 months.

"Time to discontinuation among RA treatments was similar among all three drugs, but treatment discontinuation varied among treatments for adult Crohn's disease," said Gleason. "These findings may indicate differences in effectiveness of the therapies, or they could indicate differences in the patients receiving each treatment."

"Additional research needs to be conducted to compare the effectiveness of these two treatments for adult Crohn's disease patients," Gleason concluded.

Decrease in dosage, yet costs continue to rise

In the final study, Prime researchers assessed the use and cost patterns for two BAI drugs, etanercept (Enbrel) and adalimumab (Humira). In 2011, etanercept and adalimumab were the top one and three drugs respectively, among all drug spending by Prime. Because some previous observations suggested doctors may be prescribing doses of these two drugs at higher levels than the manufacturer's label suggests, Prime reviewed 9 million commercial claims between January 2007 and June 2012 to evaluate dosing trends for each drug.

The study found that, in fact, average doses for both drugs slightly decreased over the 4.5 year period. Average milligrams per day of etanercept decreased 13.6 percent and average milligrams per day of adalimumab decreased 13 percent. At the same time, costs continued to rise for both drugs during the same period. Average daily gross costs for etanercept increased 38.3 percent, while average daily gross costs increased 38.4 percent for adalimumab. Researchers found increasing daily costs of these drugs is due to manufacturer price increases and not to increasing doses.

"These costs have become a significant burden for consumers and plan sponsors. It's more important than ever to carefully monitor costs and available treatments to make sure members are getting the best value for their care," said Gleason.

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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 20 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.

SOURCE Prime Therapeutics LLC