Nearly half of BCBS members discontinue this RA drug after 1 year

Payers should develop care and utilization management programs that encourage adherence to the most cost effective rheumatoid arthritis (RA) treatments, according to new analysis presented at the Academy of Managed Care Pharmacy (AMCP) Nexus on October 4, in National Harbor, Maryland.

Gleason

“Providers and payers should look for ways to improve persistency and consider outcomes-based contracts linked to adherence. These programs should emphasize use of a nonbiologic DMARD [disease-modifying antirheumatic drug] as first-line therapy,” study coauthor Pat Gleason, PharmD, director of health outcomes at Prime Therapeutic, told Managed Healthcare Executive.

Prime analyzed members’ use of RA drug tofacitinib (Xeljanz) to find patterns and adherence behaviors. Researchers integrated medical and pharmacy claims data for members from 12 Blue Cross and Blue Shield clients with a combined average commercially insured population of 13.8 million members per month.

Prime selected 4.4 million members with continuous enrollment from January 2012 through December 2015. Prior and concurrent DMARD assessment and persistency analysis were limited to Xeljanz users with an RA medical diagnosis.

“This allowed us to look at therapy one year prior to starting Xeljanz and to follow Xeljanz utilizers for an average of 16 months after starting their Xeljanz therapy,” Gleason said.

While use of the drug had been low, it is steadily increasing at a rate of 0.24 members per 100,000 commercially insured members per month, according to Gleason.

The study found that potentially one in 10 Xeljanz users had no DMARD claim in the year prior to beginning therapy. DMARD use would indicate following of the guideline as a first-line therapy. Meanwhile 44% had discontinued the drug at one year after starting therapy.

Prime wanted to better understand Xeljanz utilization of those with RA, according to Gleason.

“With a wholesale acquisition cost of over $42,000 per year, use, according to American College of Rheumatology guidelines, is critical for ensuring cost-effective therapy,” he said. “Due to limited Xeljanz long-term safety and efficacy information, it is important to understand real-world utilization patterns in order to develop management strategies.”

According to Gleason, there have been many new drugs with unique mechanisms of action approved in the past 10 years to treat RA.

There are now more than 15 DMARD drugs available to treat RA, some of these drugs are traditional oral DMARDs, such as methotrexate, said Gleason. Methotrexate has been used as first-line therapy for over 40 years and is available generically for less than $500 a year, while other DMARDs are injectable biologics or recently approved oral drugs that have price tags of over $1,000 per month and over $40,000 a year.

“Research has confirmed and American College of Rheumatology guidelines recommend methotrexate should be tried first, unless contraindicated due to disease or drug interactions. If methotrexate is not adequately controlling disease and if there was some response it should be continued and used in combination with the second DMARD selected,” Gleason added.