Our purpose is to help people get the medicine they need to feel better and live well. One of our studies, recently featured at the AMCP Nexus event, highlights the importance of adherence and care management — putting Prime’s purpose into practice, and showing how focusing on our members helps lower the total cost of care.
Sales of Ibrance (palbociclib) taking off, signaling importance of care management
In February, the Food and Drug Administration (FDA) granted approval for palbociclib (Ibrance), an oral kinase inhibitor, for the treatment of metastatic breast cancer. The FDA approval is only for palbociclib to be taken in combination with letrozole, an anti-hormone drug.
A study by Prime on the utilization and cost of palbociclib has earned gold status for quality research.
Primary findings: In fewer than six months post-launch, palbociclib resulted in more than $9 million in expenditures to commercial and Medicare pharmacy benefits, including five-times higher utilization and cost within Medicare. This accounted for approximately 5 percent of the analyzed population but 23 percent of the cost. Also, one in six members who started palbociclib was no longer using the drug at a two-month follow-up.
The importance of utilization management
The study found that for one in ten members, palbociclib is not being properly used with letrozole. This should be included in prior authorization criteria and care management. Waste findings show that a split fill program would have a projected annual savings of $164,220 in the 23 members with overlapping claims of different capsule strengths.
To help address these concerns, members using Prime Therapeutics Specialty Pharmacy™ receive specialized care management services including:
- Education upon starting a new therapy
- Adherence and side effect management, and
- Assessment of palbociclib/letrozole combination therapy.
This research has helped Prime develop thoughtful, member-specific clinical solutions, designed to work seamlessly for employer groups.
1. McKinsey Center for U.S. Health System Reform. (October 2014). Assessing the 2015 MA star ratings.
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