Prime Therapeutics Responds to FDA Approval of New Hepatitis C Drug

Provides use, cost forecast based on testing, future treatment rates.

Friday’s FDA approval of Gilead’s new, fixed-dose, combination Hepatitis C drug signals another spike in treatment and pharmacy costs for health plans across the country, according to Prime Therapeutics LLC (Prime).

“When Sovaldi launched earlier this year, we saw a dramatic increase in prescriptions for the drug,” said Peter Wickersham, senior vice president for integrated care and specialty at Prime. “In recent months, we’ve seen Sovaldi’s use taper off in anticipation of this new drug.”

Wickersham added that the new Gilead Sciences, Inc. (Gilead) combination drug— ledipasvir + sofosbuvir (Sovaldi) (LDV/SOF) – is expected to be as expensive as the longer-course, combination treatment, but have fewer side effects and a shorter treatment course. The new treatment delivers cure rates as high as 99 percent, potentially leading to a day where the disease may be eradicated.

Prime predicts another peak in treatment for Hepatitis C and high costs associated with this new product and others that are expected to receive FDA approvals, but then a decline in the number of people being treated for Hepatitis C in 2016 and beyond.

To help predict future demand for new drug therapies to treat Hepatitis C, Prime analyzed Hepatitis C screening rates

and estimated future diagnosis/treatment rates in its commercially insured population. The Academy of Managed Care Pharmacy (AMCP) recently recognized this first-of-its-kind study as a Platinum-level winner and invited Prime researchers to share results at a special education session during its fall conference October 7-10.

Prime’s researchers found:

• Hepatitis C testing has gradually increased since 2011, following expanded testing recommendations by the U.S. Centers for Disease Control (2012) and U.S. Preventive Services Task Force (2013) to include all people born from 1945 to 1965
• With increase in testing among baby boomer members since 2012, the rate of new Hepatitis C diagnosis has increased
• The testing rate of 90 per 100,000 commercially insured members per month results in two new individuals with a Hepatitis C diagnosis per month, which indicates new treatment rates will grow marginally or decline after members who’ve been awaiting the more effective drugs receive treatment
• Most striking, the testing rates appear to have leveled off in the past year.

Prime used this information to forecast Hepatitis C drug use and costs for its clients.

Specifically, Prime expects 32 of every 10,000 commercially insured members to be diagnosed with Hepatitis C by 2015. That’s nearly 6,000 new members diagnosed over those diagnosed prior to 2014. Prime estimates in 2014 cost trends for Hepatitis C will rise 750 to 850% over 2013 costs.

In 2015, cost trends will increase 20 to 40 percent over 2014 costs; and in 2016 cost trends will decrease 20-40% over 2015 costs*. This represents an average per member per month cost range between $3.10 and $3.50 in 2014; $4.00 and $4.75 in 2015; and $2.70 and $3.60 in 2016.

“At approximately $100,000 per treatment regimen it’s important to do all we can to help members take their medicines as prescribed,” said Wickersham. “Health plans need to work closely with their pharmacy benefit managers to effectively manage these drugs.”

*Prime Therapeutics’ 2014 forecast is based on the following assumptions:

• Average treatment cost of $122,000 (incorporates duration and treatment regimen mix)
• Among 14.8 million commercially insured members with integrated medical and pharmacy claims data.
• Newly diagnosed members 20 per 100,000/year
• New products are price parity to existing
• No Hepatitis C drug price inflation
• No treatment of members who have cleared the Hepatitis C virus on their own

About Prime Therapeutics

Prime Therapeutics LLC (Prime) helps people get the medicine they need to feel better and live well. Prime manages pharmacy benefits for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and delivers medicine to members, offering clinical services for people with complex medical conditions. Headquartered in St. Paul, Minn., Prime serves more than 25 million people. It is collectively owned by 13 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. Prime has been recognized as one of the fastest-growing private companies in the nation.

For more information, visit

www.primetherapeutics.com

or follow @Prime_PBM on Twitter.

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About Prime Therapeutics

Prime Therapeutics LLC (Prime) helps people get the medicine they need to feel better and live well. Prime manages pharmacy benefits for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and delivers medicine to members, offering clinical services for people with complex medical conditions. Headquartered in St. Paul, Minn., Prime serves more than 25 million people. It is collectively owned by 13 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. Prime has been recognized as one of the fastest-growing private companies in the nation.

For more information, visit

www.primetherapeutics.com

or follow @Prime_PBM on Twitter.

SOURCE: Prime Therapeutics