How do cost and pharmacy choice impact adherence to hepatitis C blockbusters?

The launch of Sovaldi fundamentally changed hepatitis C management. For 9 out of 10 people who receive it, it offers a cure.i But this cure comes at a high cost to health plan sponsors — more than $1,000 per pill.i These high prices made Sovaldi the second-highest grossing drug in 2014, with more than $10 billion in revenue.ii

More hepatitis C therapies with even higher price tags are available today. And claim volume won’t be receding any time soon. Managing these costs is critical to keeping health care affordable. But price is just one element. Promoting adherence is also essential. If people don’t take their medicine consistently, it doesn’t work. And billions of dollars are wasted.

What we studied

Can out-of-pocket costs and pharmacy choice significantly impact adherence and abandonment rates? To find out, Prime’s clinical researchers analyzed out-of-pockets costs, abandonment and compliance rates for members who initiated at least one Sovaldi fill at Prime Therapeutics Specialty PharmacyTM (Prime Specialty Pharmacy) and those who used other specialty pharmacies.

What we learned

When analyzing prescription abandonment data,* Prime found that:

  • Lower out-of-pocket costs resulted in lower abandonment rates.The median out-of-pocket cost for members was $94, and 68 percent paid less than $250. When members were faced with out-of-pocket costs greater than $250, abandonment rates nearly doubled. This finding echoes previous Prime research that showed limiting out-of-pocket costs to less than $250 for preferred-tier formulary drugs can dramatically impact adherence.
  • Members who used Prime Specialty Pharmacy were much less likely to abandon therapy. When compared to members using other specialty pharmacies, members who initiated their first Sovaldi fill at Prime Specialty Pharmacy were 36.4 percent less likely to abandon therapy.

When analyzing Sovaldi compliance,** Prime found that:

  • Members who filled a claim at Prime Specialty Pharmacy were more likely to stay adherent. Members who filled at least one Sovaldi claim at Prime Specialty Pharmacy were 16.5 percent less likely to discontinue therapy.

Why we did this study

Keeping medicine affordable is a core focus for Prime. Hepatitis C medicines represented a significant portion of pharmacy cost increases in 2014 and will continue to do so. By studying out-of-pocket costs, and the correlation between Prime Specialty Pharmacy and therapy adherence, we were able to define value and offer guidance that can help improve member outcomes and help clients better manage pharmacy costs.

Learn more about Prime Specialty Pharmacy and our tailored, member-centered approach to care management, education and financial assistance.


*Defined as reversing a Sovaldi claim with no additional claim in the ensuing 90 days
**Defined as 12 or more weeks of therapy

Prime Therapeutics internal research. (September 2015).

U.S. Department of Health and Human Services. (2014). Health Insurance Marketplace: Summary enrollment report for the initial annual open enrollment period. Retrieved from http://aspe.hhs.gov/health/reports/2014/marketplaceenrollment/apr2014/ib_2014apr_enrollment.pdf

Philippidis, A. (February 23, 2015). The Top 25 Best-Selling Drugs of 2014: Blockbusters Do Better with One Newcomer Reaching #2 in Its First Year. Genetic Engineering & Biotechnology News. Retrieved from http://www.genengnews.com/insight-and-intelligence/the-top-25-best-selling-drugs-of-2014/77900383/?page=2#gsaccess

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