ST. PAUL, Minn., May 7, 2013 /PRNewswire/ -- Prime Therapeutics (Prime), a leading pharmacy benefit manager (PBM), announced today that it has been awarded two Honorable Mentions in the 2012 Award for Excellence from the Journal of Managed Care Pharmacy (JMCP).
One study examined the impact of generic drug discount programs on levothyroxine (a drug to treat low thyroid) pharmacy claims data. A second study reviewed members' medication use following the implementation of a rosiglitazone (a type 2 diabetes drug) safety prior authorization (PA) policy.
Pharmacies' Generic Drug Discount Programs - Potential Impact on PBM Claims Capture
Generic drug discount programs were popularized in 2006 when pharmacies such as Walmart began offering medications for as low as $4. While the programs reduce the cost of medicine for consumers, they may also reduce a PBM's ability to capture claims data, negatively impacting the ability to provide clinical programs and adherence reporting.
Prime compared claims from 3.5 million commercially insured members filling a levothyroxine prescription between January 1, 2006, and December 31, 2010. Researchers found an equivalent number of patients who did not continue a drug purchased at a non-membership pharmacy discount program, compared to a control group. On the other hand, those purchasing a generic through a membership program pharmacy appeared to have a small but statistically significantly higher rate of members who did not continue the drug.
"Although generic drug discount programs have been prevalent since 2008, it is a common concern that PBM and health plan prescription information is incomplete due to an unknown proportion of generic drug claims that are not submitted," said Patrick Gleason, PharmD, BCPS, FCCP and lead author and director of health outcomes for Prime. "These study results suggest that health insurers and PBMs should work to ensure that claims information is complete on pharmacies with membership drug discounts."
Authors of the study were: Alexandra Tungol, PharmD; Catherine I. Starner, PharmD, BCPS, CGP; Brent W. Gunderson, PharmD; Jeremy A. Schafer, PharmD, MBA; Yang Qiu, MS; and Gleason.
The study can be found at: http://www.amcp.org/WorkArea/DownloadAsset.aspx?id=15873
Rosiglitazone Prior Authorization Safety Policy
In the second study, Prime collaborated with Florida Blue to evaluate drug use among 1.4 million commercially insured members who were exposed to a rosiglitazone PA program beginning January 1, 2009. These members were compared with a group of approximately 2 million commercially insured members who did not have this safety PA intervention.
The study found that the rosiglitazone PA was successful in significantly reducing concurrent use of nitrates and insulin among health plan members with type 2 diabetes.
"Previous studies have found that prior authorization programs reduce drug utilization and costs, but it has been unclear whether patients were impacted positively or negatively," said Gleason. "Our study is unique in that the findings support the use of a PA to promote safe prescribing as evidenced by the potential cardiovascular event risk avoidance for patients."
The authors were: Catherine I. Starner, PharmD, BCPS,CGP; Beckie Fenrick, PharmD (formerly with Florida Blue); Peter Wickersham, MS, MBA; and Patrick P. Gleason, PharmD, BCPS, FCCP (with Prime) and John Coleman, PharmD from Florida Blue.
The study can be found at: http://www.amcp.org/WorkArea/DownloadAsset.aspx?id=14970
The JMCP Award for Excellence entries are judged based on potential impact on the profession or knowledge, scientific merit and sound methodology, relevance to managed care pharmacy today, clarity of purpose and hypothesis, and writing quality and readability.
Prime received JMCP Award for Excellence honors in 2010 for its research examining the relationship between member out-of-pocket (OOP) costs and the number of patients who abandon high-cost specialty medications. In 2009, it was recognized for its research assessing rosiglitazone and pioglitazone utilization trends and associated medical and pharmacy claims data indicating risk for an adverse cardiovascular event.
Prime's 2012 Honorable Mention research studies will be recognized in a future issue of the AMCP Monthly News and posted on the AMCP/JMCP websites.
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 21 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.
*Effective July 1, 2013.
SOURCE Prime Therapeutics