News Releases

Identifying the associated medical cost savings with improving medication adherence study earns organization's platinum award

EAGAN, Minn., March 16, 2023 /PRNewswire/ -- Leading pharmacy benefit manager (PBM) Prime Therapeutics LLC (Prime) and Magellan Rx Management, (Magellan Rx), a Prime Therapeutics company, will present seven research studies at the Academy of Managed Care Pharmacy (AMCP) Annual Meeting, March 21-24 in San Antonio, Texas.

Prime and Magellan Rx used integrated medical and pharmacy claims data to evaluate real-world drug utilization and managed care pharmacy programs. Researchers explored a range of topics, including medical cost savings associated with medication adherence improvement, to an analysis of whether patient treatment through medically integrated dispensing programs versus specialty pharmacies leads to reduced drug waste and costs.

"The teams conducting this research at Prime and Magellan Rx include some of the brightest minds in managed care pharmacy focused on whole-person care to not only improve health outcomes but also save health care costs," said Pat Gleason, PharmD, assistant vice president for health outcomes at Prime. "These real-world studies demonstrate that with combined expertise, Prime and Magellan Rx are transforming the pharmacy industry, driving savings and bridging the distance between medical and pharmacy management to close gaps in care and help keep members healthier."

The following studies will be featured at this years' event:

Estimating Medical Cost Offsets from Continuous Adherence Improvement Using Commercially Insured Members' Real-World Data 

The recipient of the AMCP platinum award, this study explores the relationship between incremental improvements in medication adherence and medical spending reduction.

Increasing medication adherence is a pharmacy practice and quality metric cornerstone, which relies on medical cost offsets to quantify value. The study finds that even a 1% increase in adherence among 644,355 previously non-adherent, commercially insured members is associated with meaningful reductions in medical costs across a range of drug categories.

The results can be applied to pharmacy services improving medication adherence to report medical cost avoidance even when an individual doesn't meet an industry-defined optimal level of medication adherence. Prime's GuidedHealth^® offering, which includes medication adherence improvement programs, will use the findings from this research to enhance its value reporting.  

Measuring Medication Adherence Associated Medical Care Savings Using Commercially Insured Members' Real-World Data

As noted previously, medication adherence is a fundamental pharmacy practice and quality metric cornerstone. Medical cost offsets also quantify value in the practice, but most evidence supporting offsets from adherence is more than 10-20 years old.

This study explores the relationship between medication adherence improvement and medical spending reduction for a commercially insured population across seven key adherence measures for prevailing chronic conditions: antipsychotics, antiretrovirals, cholesterol, depression, non-insulin diabetes medications, hypertension all-class, and renin-angiotensin system antagonists. 

The study finds that moving patients from non-adherent to adherent status led to annual medical cost savings for six of the seven drug categories assessed (from $292 to $947 per person annually). What's more, improved adherence may influence health care spending for most chronic conditions. For example, if a 10,000-member population has 190 members non-adherent to a statin, and a clinical program prompts 20 members to become adherent, the results indicate $16,490 in annual medical cost savings.

Cystic fibrosis disease modifying drug therapy identification and management of cumulative drug oversupply

The recipient of the AMCP silver award, this study assesses the impact of patient stockpiling of disease-modifying drugs for cystic fibrosis (DMDCF) medication and the financial impact of a managed care pharmacy intervention program to reduce drug oversupply. As DMDCF medication costs more than $25,000 a month, excessive supply can lead to waste.

One of every 25 DMDCF utilizers were identified as having a medication oversupply involving a pattern of repeated filling at, or near, the time of 75% exhaustion of on-hand supply. This practice, also known as stockpiling, results in increased payer and member costs due to additional member copayments, as well as payer expenditures and drug waste in the event of a therapy change. 

The study describes how $610,000 in client costs associated with DMDCF refills were averted among 20 of 67 members with medication stockpiles. Managed care pharmacy interventions through Prime's HighTouchRx^® program – which uses machine learning and advanced analytics to identify oversupply intervention opportunities, along with an additional 1,500 drug therapy optimization rules – helps lower costs for health plans and members.

Oral oncolytic drug waste comparison between medically integrated dispensing and specialty pharmacies 

In 2021, Prime Therapeutics launched IntegratedRx™, which includes medically integrated dispensing (MID) of oral oncolytics – oral medications used to treat cancer – for providers. The IntegratedRx and MID service goal is to streamline cancer drug therapy treatment for members and providers through complete coordination across the cancer treatment pathway. These programs also are designed to reduce waste in oral oncolytic drug therapy treatment protocols.

Using real-world pharmacy claims data from eight commercial Blue Plans that implemented IntegratedRx services, Prime assessed oral oncolytics waste, comparing IntegratedRx MID to specialty pharmacies (SP) from July 2021 to November 2022.

The study looks at members utilizing both MIDs and SPs, and finds that among MID claims, there were 106 dose changes with an average of $2,301 waste per dose change. Among SP claims, there were 1,037 SP dose changes with an average of $3,333 waste per dose change. Waste occurs in 47 percent of MID dose changes with an average cost of $4,878 per waste event, compared to 55 percent of SP dose changes with an average cost of $6,021 per waste event. 

The study finds that oral oncolytic waste tends to occur less frequently among MID pharmacies, and if the 1,037 oral oncology therapies dispensed by SP had been dispensed at a MID pharmacy, $1.1 million may have been saved. 

Ophthalmic Vascular Endothelial Growth Factor Inhibitors: First-Year Single-Eye Therapy Cost Evaluation Using Real-World Maintenance Frequency and Claim Costs for Aflibercept, Bevacizumab and Ranibizumab 

Ophthalmic vascular endothelial growth factor inhibitors (OVEGFi) are first-line treatments for both diabetic macular edema (DME) and age-related macular degeneration (AMD). According to Magellan Rx Management's 2022 Medical Pharmacy Trend Report, OVEGFi treatments continue to be a top 10 category of medical drug spend for both Commercial and Medicare populations. It's important to note that differences exist among competing drugs in this category, such as presence of a loading dose, dosing, and varying maintenance frequency, all of which can influence treatment costs.

This study compares the expected first-year, single-eye (FYSE) therapy costs for aflibercept, bevacizumab and ranibizumab for AMD and DME by evaluating real-world maintenance frequency and single-eye claim costs using medical claims and eligibility data among both Commercial and Medicare populations.

This study finds bevacizumab with the lowest FYSE therapy cost, which was approximately $6,000-$21,000 lower than aflibercept and ranibizumab. Ranibizumab, when compared to aflibercept, was only slightly lower for AMD for Commercial and Medicare populations, but for DME, treatment was approximately $10,000 lower for Medicare and approximately $15,000 lower for Commercial populations. These findings demonstrate the importance of evaluating real-world maintenance frequencies and single-eye claim costs to model FYSE therapy cost to inform OVEGFi management strategies. FYSE evaluations will be particularly crucial in assessing new and upcoming biosimilars and extended-dose products.

Magellan Rx residents will also present two additional studies, "Classification of Ozempic and Victoza Utilizers Into On-label and Off-label Cohorts"  and "Exploring Utilization Trends of Recent Physician-Administered Biosimilar Launches." Both will explore respective patient and market data as it relates to these popular classes of drugs.

For additional insights on the studies noted above, visit Prime Therapeutics' newsroom.

About Prime Therapeutics + Magellan Rx
Prime Therapeutics LLC (Prime) is a diversified pharmacy solutions organization serving health plans, employers and government programs. Prime is collectively owned by 19 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. Magellan Rx Management, a Prime Therapeutics LLC Company, is a pioneer in specialty and medical drug management and a leader in serving public sector state government programs. Together Prime and Magellan Rx provide a wide range of clients with solutions that bridge the distance between medical and pharmacy management. For more information visit primetherapeutics.com and magellanrx.com, or follow us on Twitter at @Prime_PBM and @Magellan_Rx.

SOURCE Prime Therapeutics LLC