Specialty drug costs now make up half of the total cost of RA and hepatitis C care

Specialty drugs now account for half of the cost of treating patients with rheumatoid arthritis (RA) or hepatitis C (Hep C), according to 2 studies presented by St. Paul-based Prime Therapeutics (Prime) and Blue Cross and Blue Shield of Minnesota at the Academy of Managed Care Pharmacy’s 25^th Annual Meeting & Expo in San Diego, in April.

“The pipeline of expensive specialty drugs continues to grow, and the cost of these medications is becoming an increasing burden for patients and plan sponsors,” said Patrick Gleason, PharmD, FCCP, BCPS, director of health outcomes at Prime. “To help patients and plan sponsors receive the best value, it’s critical that we carefully monitor cost trends.”

In the first study, researchers found that despite the slight decrease in commercially insured members receiving hepatitis C specialty drug treatment from 2008 to 2011, the total cost of care for hepatitis C patients treated with a hepatitis C  specialty drug grew 15% year over year during that period. Of the total cost, specialty drug costs accounted for 35% ($13,332 of $38,055 in average annual care costs) in 2008 and climbed to 52.6% of treatment costs in 2011 ($30,415 of $57,799). Costs for specialty drugs grew 31.8% year over year during the same period, rising at a significantly greater rate than the overall cost of care.

In the second study, researchers found that although specialty RA drug use remained steady from 2008 to 2010, the total cost of care for RA patients climbed 7.3% year over year from 2008 to 2010. The total cost of care was comprised of specialty RA drug costs through the medical and pharmacy benefits, all other medical costs, and all other pharmacy costs. In 2010, members with RA utilizing a specialty RA drug annual total cost of care averaged $34,164 of which RA specialty drugs accounted for 53.0% ($18,098) with 70.8% of these costs coming from the pharmacy benefit. Specialty RA drug costs grew at a 6.9% annual rate from 2008 to 2010.

“Pharmacy costs now account for more of the cost of RA and hepatitis C care than all other treatment costs,” said Dr Gleason. “While medication use often can help bring down other medical costs, in the case of these 2 conditions, we can no longer expect medical savings to offset the costs spent on specialty drugs.”

“As we work to improve the quality of care for patients needing specialty drugs,” said Dr Gleason, “specialty pharmacy management programs will become increasingly important. Such programs include care management, networks, utilization management and rebate relationships-all tools that help pharmacy benefit managers and health plans rein in the increasing costs of these drugs.”

Both studies analyzed integrated pharmacy and medical claims from 1 million commercially insured, continuously enrolled Prime members receiving a hepatitis C or RA specialty drug.