Pharmacy Benefit Managers Could Reduce Idiopathic Pulmonary Fibrosis Treatment Costs

Treating patients with idiopathic pulmonary fibrosis (IPF) can cost Medicare an additional $1 billion per year, but pharmacy benefit managers (PBMs) could potentially help reduce costs.

Incidence of IPF for Medicare patients is 78.7 and 93.2 per 100,000 person-years, according to a study published by the American Journal of Managed Care. Researchers analyzed data from a commercial claims database and a Medicare insure database, which revealed that Medicare patients with IPF are twice as likely to be hospitalized or need outpatient visits.

The cost for Medicare patients with IPF in 2008 was $26,378, compared with $12,124 for commercially insured patients with IPF. Investigators also discovered that patients with IPF insured by Medicare had an average annual cost of $10,124 prior to diagnosis, while commercially insured patients with IPF had an average annual cost of $5888.

According to the study, patients with IPF also have higher rates of comorbidities that increase costs.

The FDA recently approved pirfenidone and nintedanib for the treatment of IPF, which costs $94,000 and $98,000, respectively, according to the study. Researchers said it is likely that treatment costs for patients with IPF will increase, especially among Medicare patients.

However, PBMs could potentially reduce the cost for this medication. PBMs have the ability to negotiate rebates and discounts from drug manufacturers since they have such a large stake in the industry, according to the study.

For IPF specifically, the new treatments have not been tested against other medications since there were no prior treatments. Researchers suggest that PBMs could potentially use that factor to negotiate discounts for exclusivity of one drug over the other, according to the study.

Researchers also believe that disease management programs offered by PBMs could reduce costs and improve access for patients. These programs monitor drug usage and efficacy, encourage patients to adhere to their medications, and provide preventative care.

PBMs also include managed utilization through benefit design, prior authorization, step therapy, and partial fills. This structure ensures lower costs for patients and payers.

Researchers concluded that PBMs would likely be able to reduce the costs of both medications, as well as provide supportive programs for patients with IPF that could result in higher adherence rates and better patient outcomes.