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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

ded to properly identify treatment candidates for other conditions. The study suggested that identifying where gaps in care exist through the use of pharmacy and medical data, can help health plans enhance outcomes for members using specialty medications.

To identify specialty condition prevalence, diagnosis and treatment, researchers from Prime reviewed integrated pharmacy and medical data from 2.6 million commercial and Health Maintenance Organization (HMO) members. Fifteen specialty conditions/drug classes were identified and defined internally.

Of the continuously enrolled members, the prevalence among the 15 specialty conditions ranged from a low of 13 members per 100,000 in hemophilia to 1,607 members per 100,000 in cancer. The majority of conditions (12 of 15) were found in less than 200 per 100,000 members. A low percentage of members identified with cancer were defined as currently treated (13.8 percent). This finding is understandable as cancer patients may be receiving palliative care or in remission. The conditions/drug classes with the highest percentage of treated members were transplant/immunosuppressants (94 percent), cystic fibrosis (93 percent) and HIV (92.8 percent). The most untreated condition was macular degeneration (7 percent).

"Based on the prevalence, number of members treated and drug spend found in the study, it is becoming increasingly apparent that health insurers need to understand treatment patterns for cancer and autoimmune conditions," Gleason said. "For example, the second most common specialty condition of Rheumatoid Arthritis (RA)/Psoriasis had less than half (44.0%) of patients treated with a specialty drug. Increasing the use of drugs in only a small percent of this untreated population would have a dramatic impact on expenditures. Utilizing specialty medication analyses based on medical and pharmacy data allows health insurers to identify important trends and patterns in the specialty drug space that may
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SOURCE Prime Therapeutics
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