Blockbuster drugs are at the forefront of today’s soaring drug costs as more drug therapies launch with five and six-figure price tags per treatment. Properly preparing for the impact of these new, high-cost drugs is critical to successfully managing drug costs.
We’re excited to announce a new tool that can help you plan for upcoming blockbuster drugs. This tool is available at no additional cost. It offers instant information on estimated use and cost impact for new and future high-cost drugs.
How the drug cost calculator works
The drug cost calculator estimates the number of individuals with a particular diagnosis who would potentially be eligible for treatment with a new, high-cost drug. It also provides a per member per month (PMPM) cost estimate. This information is a first step toward awareness. And it can fuel discussions about Blue Cross+ Prime’s solutions to help you manage high-cost drugs.
Our researchers extensively analyzed select disease states that are expected to have new drug treatment regimens available. This information, combined with medical and pharmacy claims analysis, powers the tool.
The drug cost calculator estimates costs for newly approved or soon to be approved drugs that will have a considerable impact on PMPM spend. Currently, the disease state and drugs available within the tool include:
- Idiopathic pulmonary fibrosis — Ofev and Esbriet (approved)
- Plaque psoriasis — Cosentyx (approved)
- Hepatitis C — Sovaldi, Harvoni, Viekira Pak (all approved)
- Lung cancer (advanced metastatic squamous non-small cell lung cancer [NSCLC]) — Opdivo (approved)
- Cystic fibrosis — Orkambi (approved)
- High cholesterol (PCSK9s inhibitors) — Repatha and Praluent (Praluent approved on July 24; Repatha expected to be approved later this summer)
- Heart failure— Entresto (approved)
How to access the drug cost calculator
Find the drug cost calculator at https://www.primetherapeutics.com/en/drug-cost-calculator.html. This tool works best for employers or groups with 10,000 or more employees/covered lives because the prevalence of these rare conditions is often low. For example, look at the condition cystic fibrosis. Prime analysis found 4.5 per 100,000 commercially insured members would meet the criteria to be treated with Orkambi. You can still use the calculator if you have less than 10,000 employees. For example, if you have 1,000 commercially insured lives, the calculator will estimate that you may have no employees with cystic fibrosis that meet the criteria. However, if you know you have employees with cystic fibrosis, or want to know how one employee with that condition might affect your costs, the calculator has a place where you can enter known affected lives.
 This tool works best for employers or groups with 10,000 or more employees/covered lives because the prevalence of these conditions is often low. The calculator is available for commercial populations only.