Study: Drug costs for hereditary angioedema tripled in 2 years

April 15, 2015

Patients with hereditary angioedema (HAE) are accruing specialty drug treatment costs of more than $300,000 annually on average, according to a study presented at the Academy of Managed Care Pharmacy (AMCP) 27th Annual Meeting and Expo, in San Diego.

Patients with hereditary angioedema (HAE) are accruing specialty drug treatment costs of more than $300,000 annually on average, according to a study presented at the Academy of Managed Care Pharmacy (AMCP) 27th Annual Meeting and Expo, in San Diego.

HAE is a rare genetic disorder that results in potentially life-threatening edema or swelling of limbs, abdomen, face, tongue or larynx-affects about 20 in 1 million Americans and still fewer commercially insured members.

According to the study, by pharmacy benefit manager Prime Therapeutics LLC (Prime), those costs tripled in the last 2 years. Prime recommended programs to help people with HAE and their health plans manage their condition to help improve care and reduce the growing cost of HAE care.

HAE drug treatments can address acute attacks or help prevent attacks in patients who experience frequent episodes. The drugs range from about $5,000 to more than $11,000 per dose (wholesale acquisition cost). The researchers wanted to understand the use of HAE drugs in order to identify opportunities to improve management of people with the condition.

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Costs need to be evaluated on both medical and pharmacy benefits because some drugs are given by infusion in a medical facility, and others can be self-injected. Hence, Prime researchers reviewed integrated pharmacy and medical claims for 12.5 million members between January 2012 and March 2014. They identified members with claims for 1 of 4 specialty drugs prescribed for HAE: Berinert, Cinryze, Firazyr, and Kalbitor. A fifth treatment available today, Ruconest, entered the market in September 2014, after the study was completed, so it was not included in this analysis.

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During the 2-year study, Prime identified 17 in 1 million commercially insured members as having a HAE diagnosis. Further analysis revealed 212 members had used a HAE drug, with more than $69 million in HAE drug costs, averaging $325,675 per member. Furthermore, 23 people out of 12.5 million commercially insured members had more than $1 million in HAE drug costs. In total, $45,385,602 (66%) of HAE drug costs were paid through the medical benefit and $23,657,387 (34%) were paid through the pharmacy benefit.

NEXT: Per member per month cost of HAE drugs increased 191% from 2012 to 2014

 

Prime also identified that quarterly HAE drug costs nearly tripled in 2 years. Per member per month (PMPM) cost of HAE drugs increased 191% from $0.11 in the first quarter of 2012 to $0.32 PMPM in the first quarter of 2014. Higher costs were partially driven by the number of members taking these specialty drugs increasing substantially. In the first quarter of 2012, 45 members received a HAE drug, compared to 118 members in the first quarter of 2014, a 162% increase.

Dr Gleason“First, HAE is sometimes a diagnosis of exclusion as the laboratory tests may be negative,” said Patrick Gleason, PharmD, director of health outcomes at Prime. “An individual may have unexplained swelling and receive an HAE diagnosis. HAE drugs may be used for these individuals with unexplained swelling without really knowing if they are working or should be used. It is essential that patients with HAE be managed by specialists. Therefore, insurers and self-insured employers should have HAE prior authorization criteria in place to ensure appropriate HAE drug therapy is occurring.”

Next, because HAE drugs span both the pharmacy and medical benefits, the most effective strategy is for the health plan to work closely with their PBM, have the PBM integrate the medical and pharmacy data, then analyze the channels offering the lowest net cost per unit from which to dispense the HAE drug, according to Dr Gleason.

“Sometime the lowest net cost can be found on the medical benefit as the medical provider can purchase drugs at a lower cost due to their class of trade status and their willingness to agree to a lower per unit contract than the pharmacy channel,” he said. “A preferred formulary product or products may be an opportunity. Additionally it is essential that case managers help HAE patients navigate their medical and pharmacy benefits and understand their HAE drug utilization.”

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