Prime Therapeutics recognized with PBMI's 2015 Rx Innovation Award

Mar 3 2015

Prime Therapeutics LLC (Prime) received the Pharmacy Benefit Management Institute's (PBMI) 2015 Rx Innovation Award today in recognition of its innovative "Specialty Drug Watch List." The Watch List identifies potential blockbuster drugs and provides early, actionable clinical intelligence to clients about the use and cost impact of drugs awaiting FDA approval.

PBMI provides research and education to help health benefit executives improve management of pharmacy benefits and control costs. Jane Lutz, PBMI's executive director, presented the award to Peter Wickersham, Prime's senior vice president for cost of care and specialty, during its 20^th Annual Drug Benefit Conference in San Antonio.

"Prime is honored to be recognized by PBMI for the way we use our unique connections with our Blue Plan clients to get ahead of blockbuster drug launches and develop aggressive strategies that help members get the medicines they need," said Wickersham. "Our 'Watch List' allows us to work with clients proactively to define our drug management strategies using in-depth trend forecasting, frequent communication, and enhanced operational implementations; ultimately leading to effective management of high-cost drugs."

Preparing clients for Sovaldi®, the $1,000 per pill hepatitis C drug approved in late 2013, proved to be an extremely important, first case study for Prime's Watch List. Positive results prompted Prime to quickly expand the list to include several other drugs that came to market in 2014 or are expected to be approved this year (e.g., Esbriet® and Ofev® for idiopathic pulmonary fibrosis, Cosentyx® secukinumab for plaque psoriasis, Ibrance® palbociclib to treat breast cancer, PCSK-9 drugs to treat high cholesterol).

Prime's objectives with the Watch List were to:

1. Help clients control costs and achieve a negative hepatitis C drug cost trend in 2016 by

• building a cost forecast model based on actual testing rates and new diagnosis incidence
• improving operational readiness, e.g., adopting "fast path" utilization management strategies

2. Increase proactive communication to improve budgeting and utilization management decisions

3. Increase available data to be used to negotiate lower drug costs through purchasing discounts and rebates

4. Help eligible members afford the medicines.

In the case of hepatitis C, rather than basing cost forecasts on population-based estimates of the number of hepatitis C patients, Prime determined testing and treatment rates on actual medical and pharmacy claims data of 12 million commercially insured members. That analysis found lower actual rates of testing and new diagnosis, resulting in a lower forecast than general population estimates. Testing and new diagnosis of our members has remained lower than general population predictions through 2014.

Using this diagnosis and treatment research, Prime created a forecast for hepatitis C new treatment start rates and per member per month (PMPM) costs. Prime also improved operational readiness for managing hepatitis C medicines in several ways. One example is "fastPAth," early designation of high impact drugs to enable implementation of utilization management (UM) strategies at the time of drug launch. Another is a Watch List cost impact indicator ranging from $ to $$$$ to help clients anticipate a drug's impact on the medical or pharmacy benefit. It also assesses whether the spending is new or reflects a shift in utilization from other medications.

Prime's enhanced communication strategy also helps clients make utilization management decisions about blockbuster drugs that could ultimately impact budgets and premium levels.

All told, as a result of Specialty Drug Watch List efforts to specifically manage hepatitis C, Prime's clients were able to take proactive, comprehensive management steps that trimmed their hepatitis C medicine costs by 38 percent, in 2014.

Prime's new Specialty Drug Watch List approach also provided significant reduction in hepatitis C medicine costs and improved adherence. For example:

• Prior authorization program saved more than $7.6 million between April 1 and June 30, 2014, or $0.59 PMPM, and
• Prime Specialty Pharmacy's patient assistance program worked to help keep member copays below $250 to improve adherence, by securing more than $3 million in hepatitis C medicine copay offsets (manufacturer coupons and patient assistance programs) during 2014.