Study: Drug Costs for Rare Hereditary Angioedema Disorder Tripled in Two Years
A new drug, increasing use, extreme costs highlight need for integrated claims data to better identify people with the disorder, develop clinical programs that improve care, reduce costs
Apr 06, 2015, 11:25 ET from Prime Therapeutics LLC
ST. PAUL, Minn., April 6, 2015 /PRNewswire/ -- Hereditary angioedema (HAE) – a rare genetic disorder that results in potentially life-threatening edema or swelling of limbs, abdomen, face, tongue or larynx – affects about 20 in 1 million Americans and still fewer commercially insured members. Yet individuals with the condition are accumulating specialty drug treatment costs of more than $300,000 annually on average, and according to a new study by pharmacy benefit manager Prime Therapeutics LLC (Prime), those costs tripled in the last two years. Researchers will present the study on April 9 at the Academy of Managed Care Pharmacy (AMCP) 27th Annual Meeting and Expo in San Diego, and recommend programs to help people with HAE and their health plans manage their condition to help improve care and reduce the growing cost of HAE care.
HAE drug treatments can address acute attacks or help prevent attacks in people who experience frequent episodes. But the specialty drugs carry a significant price tag, ranging from about $5,000 to more than $11,000 per dose (wholesale acquisition cost). Prime set out to understand the use of HAE medicines in order to identify opportunities to improve management of people with the condition.
Costs need to be evaluated on both medical and pharmacy benefits because some drugs are given by infusion in a medical facility, and others can be self-injected. Hence, Prime researchers reviewed integrated pharmacy and medical claims for 12.5 million members between January 2012 and March 2014. They identified members with claims for one of four specialty drugs prescribed for HAE: Berinert®, Cinryze®, Firazyr®, and Kalbitor®. A fifth treatment available today, Ruconest®, entered the market in September 2014, after the study was completed, so it was not included in this analysis.
During the two-year study, Prime identified 17 in 1 million commercially insured members as having a HAE diagnosis. Further analysis revealed 212 members had used a HAE drug, with more than $69 million in HAE drug costs, averaging $325,675 per member. Furthermore, 23 people out of 12.5 million commercially insured members had more than $1 million in HAE drug costs. In total, $45,385,602 (66%) of HAE drug costs were paid through the medical benefit and $23,657,387 (34%) were paid through the pharmacy benefit.
Prime also identified that quarterly HAE drug costs nearly tripled in two years. Per member per month (PMPM) cost of HAE drugs increased 191 percent, from $0.11 in the first quarter of 2012 to $0.32 PMPM in the first quarter of 2014. Higher costs were partially driven by the number of members taking these specialty drugs increasing substantially. In the first quarter of 2012, 45 members received a HAE drug, compared to 118 members in the first quarter of 2014, a 162 percent increase.