Support members with autoimmune diseases

We help members navigate their autoimmune diseases with our holistic, customized approach to care.

Learn more about autoimmune diseases  

Autoimmune diseases happen when your immune system is overactive and can't tell the difference between your own cells and foreign cells, causing the body to mistakenly attack normal cells. There are more than 100 different types of autoimmune diseases (e.g., rheumatoid arthritis, psoriasis, Crohn's disease, ulcerative colitis).1 

50M

As many as 50M people in the United States have an autoimmune disease, making it the third most prevalent disease category, surpassed only by cancer and heart disease.2

Many high-cost autoimmune drugs are covered under the medical benefit. However, management across both benefits is critical to understanding total cost of care and uncovering additional savings opportunities.3 

The autoimmune drug category has 25+ specialty drugs, treating more than 10 conditions led by rheumatoid arthritis disease, dermatologic diseases and inflammatory bowel disease (IBD). Autoimmune drug category continues to lead all others despite recent biosimilar competition.3 

Based on Prime’s real-world data, annual IBD autoimmune drug therapy adherence is 65%, and autoimmune drug costs account for 70% of the total cost of care.3 

1 in 100

One in every 100 of Prime’s commercially insured members had an autoimmune drug claim in the most recent quarter.3

A comprehensive approach to savings

Clinical rigor 

Help your members get the right treatments with comprehensive policies, proactive pipeline monitoring and rigorous utilization management (UM). 

Lower-cost medications 

Manage across benefits and direct members to clinically appropriate, lower-cost medications, in the right care setting. 

Lowest net cost 

Implement lowest-net-cost strategies like biosimilars and shifts to lower-cost sites of care when applicable. 

Specialized pharmacists 

Get support from specialized pharmacists who reach out to providers to optimize drug therapy and report savings back to you. 

Choose what works best for you and your members 

Footnotes

*All brand names are property of their respective owners.
**The programs listed are not available to all clients. Please check with your representative if you are interested in learning more.
1 Autoimmune disorders. (n.d.). Mount Sinai Health System. https://www.mountsinai.org/health-library/diseases-conditions/autoimmune-disorders
2 Autoimmune diseases. (n.d.). National Institute of Environmental Health Sciences. https://www.niehs.nih.gov/health/topics/conditions/autoimmune#:~:text=As%20many%20as%2050%20million,significant%20role%20in%20disease%20development
3 Internal analysis, 2024