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Study Finds Utilizing Integrated Medical and Pharmacy Data Improves Ability to Forecast Use of High-cost Specialty Treatments
Date:4/20/2012

SAN FRANCISCO, April 20, 2012 /PRNewswire/ -- Health insurers should use both medical and pharmacy data to forecast specialty medication utilization and improve outcomes for members, according to a new study by pharmacy benefit manager Prime Therapeutics (Prime). The study will be presented today at the Academy of Managed Care Pharmacy (AMCP)'s 24th Annual Meeting & Expo in San Francisco.

Pharmacy benefit managers (PBMs) have experienced a rapid rise in expensive specialty prescription drug use within the past few years. In 2011, specialty drugs comprised 0.5 percent of all claims but 15.2 percent of all prescription benefit expenditures across Prime's member network. In addition, the average specialty per-prescription cost was $2,637 in 2010 and total paid per capita increased 12.9 percent from 2010 ($10.24 to $11.36 per member per month). Previous studies have estimated that specialty medication drug spend could increase from 20 percent to 50 percent by 2030, highlighting the need for health insurers to better understand how to trend and forecast these costs due to rapid growth rate.

"Specialty drugs offer life-saving treatment for patients with chronic illnesses, but they also carry a huge price tag, continuing to rise by double digits each year," said Patrick Gleason, PharmD, director of clinical outcomes assessment at Prime. "Health insurers and plan sponsors need to be able to forecast these costs and also ensure the best outcomes for their members. For example, it's critical that insurers understand that of the 81.9 percent of members with Hepatitis C identified as untreated many are likely to receive care in the near future because new drugs have recently become available."

According to Prime's analysis, it may be easy to identify prevalence and treatment rates via International Classification of Disease, Ninth Revision (ICD9), procedure code and pharmacy claims for some diseases. However, more sophisticated algorithms may be nee
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SOURCE Prime Therapeutics
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