Radar on Specialty Pharmacy

  • Integrated Medical, Pharmacy Claims Give Full View of AI Class

    Some companies that analyze specialty drug spend do so with a focus solely on the pharmacy benefit. This approach, however, may fail to take into account a significant amount of medical benefit spending within certain conditions, including inflammatory diseases. A recent study by Prime Therapeutics LLC revealed trends across both benefits for the conditions, which account for almost 20% of all pharmacy and medical benefit drug expenditures among Prime’s commercially insured book of business. It also demonstrated that the class may benefit from indication-based pricing.

    The study was presented at the Academy of Managed Care Pharmacy’s AMCP 2021 virtual conference in April.

  • Study Finds Good Adherence, Low ADE Rates With Oral DMTs

    The multiple sclerosis (MS) therapeutic class boasts more than 20 disease modifying therapies (DMTs) that have various routes of administration. A recent study of oral therapies to treat relapsing-remitting MS (RRMS) found that they are well tolerated, have high adherence rates and have low rates of adverse events.

    AllianceRx Walgreens Prime conducted the research in conjunction with Duquesne University School of Pharmacy. The study was presented at the Academy of Managed Care Pharmacy’s AMCP 2021 virtual conference in April.

  • Report: Specialty Drug Spending May Be Slowed by Biosimilars

    Based on invoice price levels, the IQVIA Institute for Human Data Science anticipates that the global medicine market will experience a 3% to 6% compound annual growth rate (CAGR) through 2025. Oncology and immunology are the top two therapy areas globally, and they are expected to grow 9% to 12% CAGR during the same time period, according to the company’s recently released report titled Global Spending and Usage of Medicines: Outlook to 2025.

    “Despite the pandemic causing significant disruption to health care systems and the use of medicines in the early part of 2020, the overall impact on medicine use was relatively modest during the year,” says Murray Aitken, IQVIA senior vice president and executive director of the IQVIA Institute for Human Data Science. “This was in part because of significant stockpiling of chronic medicines in advance of movement restrictions and higher demand for some drugs used in the treatment of COVID-19 patients, which offset fewer new therapy starts and delays in treatment. The pandemic reinforced the resilience of the pharmaceutical sector and its adaptability, even in the most challenging of times.”

  • Precision Oncology Solution Aims to Improve Patient Outcomes

    With more and more oncolytics targeting specific alterations in tumors, the area of precision oncology is developing rapidly. To help bring some insight into this market, Magellan Rx Management, a division of Magellan Health, Inc., and Trapelo Health, a wholly owned subsidiary of NeoGenomics Bioinformatics, recently unveiled a collaboration aimed at helping both providers and payers navigate this complex space and ultimately improve patient outcomes.

    The offering combines Magellan Rx’s comprehensive oncology management solution and Trapelo’s precision-medicine platform, which provides fast, accurate testing and treatment decision support. Trapelo links providers, laboratories and payers by providing access to molecular testing information, allowing providers to order tests from preferred labs and interpreting those results, including identifying appropriate, evidence-based treatments. It offers automated prior authorization, incorporates health plan policies and eliminates unneeded medical redocumentation. These services will support Magellan Rx’s medical pharmacy program, which addresses various aspects of cancer care such as guideline-supported prior authorization, drug waste, personalized dosing, oral oncology management, post-service claim edits and provider network management.

  • Study Finds Wide Variation in Payers’ CAR-T Drug Costs

    Chimeric antigen receptor T cell (CAR-T) therapies have been available in the U.S. since August 2017. While the list prices for the one-time treatments are known, a recent study from Prime Therapeutics LLC examined their total cost of care and clinical events following administration and found that payer costs for the therapies varied widely. Payers could use this information to help forecast costs for these drugs and strike value-based deals, says one author of the study, which was presented at the Academy of Managed Care Pharmacy’s AMCP 2021 virtual conference in April.

    Study Examined First Two CAR-Ts

    Researchers examined the first two CAR-Ts on the U.S. market. Yescarta (axicabtagene ciloleucel) from Kite Pharma, Inc., a Gilead Sciences, Inc. company, was approved Oct. 18, 2017, for the treatment of adults with relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy (RSP 11/17, p. 8). The drug — which gained FDA approval for relapsed or refractory follicular lymphoma after at least two forms of treatment on March 6 (RSP 4/21, p. 8) — is priced at $373,000.

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