ST. PAUL, Minn., March 7, 2012 /PRNewswire/ -- Prime Therapeutics (Prime), a leading pharmacy benefit manager (PBM), and EMD Serono, Inc., a leader in the U.S. biopharmaceutical market and subsidiary of Merck KGaA, Darmstadt, Germany, have entered into an agreement bringing the first outcomes-based rebate contract for a multiple sclerosis (MS) drug to Prime's CareCentered Contracting program. As an integrated PBM with its health plan clients, Prime is uniquely positioned to ensure members are taking effective prescription medications that truly improve their health by evaluating outcomes data throughout the entire length of the contract.
"With more than 57 percent of the direct health care costs to treat MS in the United States related to drug expenses, it is important to focus on medication adherence and cost effectiveness to ensure the greatest health benefit for each dollar spent," said Peter Wickersham, senior vice president of cost of care at Prime. "Our CareCentered Contract with EMD Serono goes beyond outcomes to do just that. It includes the total cost of care component, inclusive of medical and pharmacy costs and medication adherence."
The contract, which began January 1, stipulates that EMD Serono will pay rebates to Prime on the utilization of Rebif (interferon beta-1a) if patients who are on the drug have a higher overall total cost to their plans than patients on a different MS drug, or if the medication adherence rate remains above a specified level. Prime will evaluate data pertaining to the health outcomes and medication adherence of patients a number of times throughout the contract in order to determine the total cost of care, including medical and pharmacy costs.
"Enabling excellent patient and payer outcomes is more important than ever for biopharmaceutical manufacturers in today's health care environment," said Mike Dezelan, senior vice president of managed markets at EMD Serono. "Our innovative contract with Prime will bring greater focus to patient adherence, which we expect will help keep hospitalization and emergency visits to a minimum and maximize cost effectiveness."
Traditionally, pharmaceutical rebate contracts negotiated by PBMs were based solely on the volume of drugs purchased. As growing numbers of high-cost specialty products enter the market, drug manufacturers are being asked to substantiate the value their medications can provide when taken appropriately, such as keeping patients out of the hospital and slowing disease progression. As an integrated PBM, Prime is uniquely able to evaluate these health outcomes by coordinating pharmacy and medical data for its health plan owners.
The Rebif agreement with EMD Serono is the third CareCentered Contract that Prime has entered into with pharmaceutical partners in the last 12 months. Other chronic diseases of focus thus far have included osteoporosis and diabetes.
Prime Therapeutics is a pharmacy benefit management company dedicated to providing innovative, clinically-based, cost-effective pharmacy solutions for clients and members. Providing pharmacy benefit services nationwide to nearly 20 million* covered lives, its client base includes Blue Cross and Blue Shield Plans, employer and union groups, and third-party administrators. Headquartered in St. Paul, Minn., Prime Therapeutics is collectively owned by 13 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those Plans. Learn more at www.primetherapeutics.com.
SOURCE Prime Therapeutics