Integrated support for patients with cystic fibrosis drives down cost, improves medication adherence - Prime Therapeutics
Integrated support for patients with cystic fibrosis drives down cost, improves medication adherence
Prime’s IntegratedRx® – Cystic Fibrosis product earns 94% member satisfaction rate
About 40,000 adults and children in the United States live with cystic fibrosis, a condition caused by a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene that impacts the lungs and digestive system. Nearly half of people with the condition have had to delay or forego care altogether, most often because of high treatment costs.
Prime Therapeutics (Prime) medical and pharmacy claims data show cystic fibrosis drug therapy is the ninth most expensive drug category. Last year, the U.S. Food and Drug Administration (FDA) approved the triple-combination modulator vanzacaftor/tezacaftor/deutivacaftor (Alyftrek™) to treat patients with cystic fibrosis aged 6 and older, as well as the expanded indication for elexacaftor/tezacaftor/ivacaftor (Trikafta®) for patients aged 2 and older. While exciting advancements, these therapies cost $300,000 or more annually.
“Cystic fibrosis therapies are constantly evolving, but unfortunately their high cost doesn’t change,” said Nathan Downhour, PharmD, senior vice president, health care services at Prime. “No patient should be unable to receive life-altering treatment because of prohibitive costs. That’s why at Prime, we’re thrilled to offer products that are proven to drive down drug costs and make medications more affordable and accessible.”
Provider has minimal connection to central specialty pharmacy.
The provider, pharmacist and member are connected.
How Prime’s high-touch, integrated support simplifies treatment journey, drives savings
There are a number of ways Prime works to achieve lower drug prices and simplify the patient experience for patients with cystic fibrosis. The first is by working with prescribers and pharmacies to ensure the therapeutic regimen is appropriate and cost effective. HighTouchRx® identifies opportunities to reduce costs, such as by working with pharmacies to ensure appropriate refill frequency, help reduce stockpiling of these high-cost medications and work with prescribers to reduce the use of duplicative therapies. This product has delivered more than $8 million in cystic fibrosis drug savings, according to Prime internal data.
“HighTouchRx combines cost effectiveness with high-quality care, offering our clients a powerful tool to drive down drug costs,” said Marie Wimmer, senior program manager.
Prime also simplifies the patient experience through its award-winning IntegratedRx®, which helps ensure pharmacists and providers are on a cohesive care team. This product, which was highlighted in the latest Prime Therapeutics Report, creates more direct lines of communication, thereby promoting improved adherence, shortening dispensing times and creating an overall better member and provider experience. IntegratedRx – Cystic Fibrosis drives $28,000 in annual savings per utilizing member, according to 2024 Prime data. It also delivers a 12% better discount on the average wholesale price (AWP) of a brand-name drug compared to using a central-fill service. Ninety-four percent of utilizing members are satisfied or very satisfied with their experience.1
“Communication, cohesion and collaboration are all key to improving the health care industry, and that’s at the heart of IntegratedRx,” said Jason Graveline, senior product director. “We’re proud to lead the industry when it comes to impact — saving costs for our clients, simplifying the patient journey and supporting those with cystic fibrosis as they manage a complex and often debilitating condition.”
Prime also recently added cystic fibrosis to its suite of clinical offerings through GuidedHealth®, a medication management product that aims to address underuse, overuse, drug safety and preferred use of medications. This product provides actionable, clinical intelligence to prescribers, members and plans to help guide members to effective medication, resulting in improved care, safer medicine use, better health outcomes and an overall lower cost of care.
“We’re thrilled to collaborate with clients to develop programs that close treatment gaps and offer the kind of care we’d want for our loved ones,” said Steve Heavrin, senior director of Health Insurance Marketplace in the announcement about the clinical addition. “Our team is committed to helping members effectively manage their medications throughout their treatment journey.”
Prime leads industry on health outcomes research, evidence-based decision-making
While Prime’s clinical tools can help guide medication decisions, they also reinforce the importance of adherence and persistence among cystic fibrosis patients.
Prime’s real-world CFTR drug treatment cost offset and value assessment found that while treating patients with CFTR drugs helps reduce medical costs associated with cystic fibrosis, they aren’t financially efficient with a 9:1 return on investment. That means it’s essential members stick to their treatment plan to receive the best medical benefits, and drugs must be delivered in the most cost-effective way.
Similarly, identifying fraud, waste and abuse in this area can also offer savings opportunities.
At Academy of Managed Care Pharmacy (AMCP) Nexus in 2024, Nick Friedlander, PharmD, clinical program pharmacist, presented research that highlighted the importance of pharmacist outreach to delay refills for cystic fibrosis patients using dupilumab who had substantial drug supply on hand. These efforts resulted in more than $1 million in savings in just a single year.
“Considering the relatively high frequency of medication accumulation involving high-cost products, this concept can likely be effectively applied across a wide variety of therapeutic areas,” Friedlander shared in an article elaborating on the research findings.
May is Cystic Fibrosis Awareness Month
Prime Therapeutics is proud to support the cystic fibrosis community during Cystic Fibrosis Awareness Month. This month is dedicated to raising awareness about cystic fibrosis, a genetic disorder that affects the lungs and digestive system. The theme, “Together for CF,” emphasizes the importance of community support and collaboration in improving the lives of those affected by cystic fibrosis. Join us in advocating for better treatment, care, and research advancements. Learn more at CFF.org/Cystic-Fibrosis-Awareness-Month.
Learn more about how Prime helps clients and members manage cystic fibrosis
Hear how Prime Therapeutics is reimagining pharmacy for its loved ones
References
- Q2 2024 Prime member satisfaction survey
About Prime Therapeutics
Prime Therapeutics LLC (Prime) is a diversified pharmacy solutions organization. We offer innovative pharmacy benefit management, specialty and medical drug management, and state government solutions to millions of people across the country. At Prime, we’re reimagining pharmacy solutions to provide the care we’d want for our loved ones. We challenge the way it’s always been done to develop intelligently designed solutions that deliver savings, simplicity and support to help people achieve better health. For more information, visit us at PrimeTherapeutics.com or follow us on LinkedIn.