Prime Therapeutics Release: New Study Supports 15-Day Fill Program for Oral Cancer Medications and Again Demonstrates Lower Adherence Associated With Higher Patient Out-Of-Pocket Costs  
11/30/2012 9:09:33 AM

ST. PAUL, Minn., Nov. 30, 2012/PRNewswire/ -- Health plans should consider implementing split fill programs for oral oncology medications to help improve patient adherence and lower costs over time, according to a new study by pharmacy benefit manager Prime Therapeutics (Prime), in collaboration with Jonas de Souza, MD, Instructor of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center. The study is being presented today, November 30, 2012, at the American Society of Clinical Oncology (ASCO) Quality Care Symposium in San Diego.

Researchers analyzed the impact of cost, adherence rates and amount of prescription wasted among patients prescribed the oncology medication erlotinib (Tarceva®). The study showed less than two-thirds of patients taking erlotinib, a once-daily oral tablet approved by the Food and Drug Administration (FDA) to treat non-small cell lung and pancreatic cancers, were adherent during the established 180-day follow-up period. Additionally, one in four patients taking erlotinib was estimated to have "wasted" their medication meaning they stopped taking the drug before they finished the 30-day supply bottle. According to the study, if a "split fill program" (reducing prescription fill times from 30- to 15-day supplies), had been implemented, an estimated $53,273 in drug expenses may have been avoided.

"The results of this study suggest the need for health plans to adopt specialty pharmacy programs for oral oncology medications that will help patients better adhere to their prescriptions, avoid waste, and ultimately, improve health and manage long-term costs," said Pat Gleason, PharmD, FCCP, BCPS, director of health outcomes with Prime. "Benefit design should consider the potential impact of 15- versus 30-day supplies, as these factors may significantly impact patient care and costs over time."

As part of this same study, researchers found higher out-of-pocket (OOP) costs negatively impacted medication adherence. Among new users, nearly two-thirds had an OOP less than $100, while a third had an OOP greater than $100. Those with an OOP greater than $100 were significantly more likely to stop their therapy compared to those with lower OOPs (45.5 percent vs. 21 percent).

"High out-of-pocket costs can help plan sponsors manage the costs of these expensive drugs in the short term, however it can have a long-term impact if patients stop taking their medication," said Gleason. "For lung cancer patients, costs could be higher over time if they stop their drugs and the disease progresses. Plans need to carefully consider the impact of out-of-pocket costs on patient care and on the total cost of care."

The study analyzed medical and pharmacy claims data from four commercial Blue Cross and Blue Shield plans with approximately 3.4 million lives who receive Prime pharmacy benefit coverage in the central and southern United States. From January 1, 2011 to June 30, 2011, more than 81 percent of 125 total erlotinib claims were for lung cancer, over 14 percent were for pancreatic cancer and 4 percent were for other cancers. There were 60 new users. Medication adherence was defined as continuous therapy through the 180-day follow up period without exceeding a gap of more than 45 days with no medication.

Oral oncology medications are considered specialty drugs, which are high-cost therapies that often require complex care. While specialty drugs account for a small percentage of overall pharmacy spending today, costs are rising rapidly. In 2011, based on Prime Therapeutics' book of business, the average paid for a one-month supply of a brand oral oncology medication was $4,177, a 15.62 percent increase over 2010. Because of the rapid increase in costs, insurers have looked for opportunities to best manage spending, including having patients fill their oral oncology prescriptions from a specialty pharmacy where they can receive specialized care.

About Prime Therapeutics
At Prime Therapeutics, people are at the center of all we do and every decision we make. As a leader in pharmacy benefit management, Prime is dedicated to making it easier for our members to obtain more affordable medicines. We leverage our unique connections to deliver programs that lead to the best health outcomes.

Prime's integrated pharmacy benefit management services include claims processing, benefit plan design, network management, clinical program consultation, rebate management, formulary administration, mail-service pharmacy and specialty pharmacy.

Headquartered in St. Paul, Minn., Prime Therapeutics serves nearly 20 million people and 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 by Inc. 5000 and as a most engaged workplace by Achievers.

For more information, visit or follow @Prime_PBM on Twitter.

SOURCE Prime Therapeutics