April 20, 2020
With hemophilia, many factors come into play
Keeping a close eye on the drug pipeline helped save millions in annual costs and reduced bleeding episodes for a 14-year-old boy with hemophilia
It’s true that hemophilia is rare, complex and expensive. But it’s also true that with good care and treatment, people with hemophilia can live full and productive lives.
Analysis Prime conducted in 2015 showed that annual drug costs for members using hemophilia factor products ranged from about $1,000 to just over $4 million.1
There’s a big cost range because cases can be mild, moderate or severe. And factor products work differently for different people. Some patients try many factor products before finding a successful treatment. Plus, over time, some patients develop inhibitors in their blood that can make factor products less effective. Treatment plans may need to change over time.
In hemophilia, utilization and care management strategies can help improve the quality of care and potentially save tens, even hundreds of thousands of dollars per member. How can we make sure that treatment is sustainable for the health care system? Where is the line between cost-efficient and cost-inefficient care?
With specialty conditions like hemophilia, this can only be determined one patient at a time, in consultation with the patient’s doctor.
In this case study, many factors came into play
For one young man with hemophilia, doctors had tried many factor products. The patient was not responding well and still had many breakthrough bleeding episodes. Costs were more than $4 million a year.
Prime monitors the drug pipeline carefully and saw a new factor product. This could be a game changer for this patient. Prime account management consulted with representatives of the Blue Plan. They got in touch with the member’s clinical specialist team to develop a new treatment plan. Once the new drug was approved by the Food and Drug Administration (FDA), Prime made this specialty drug available for the member.
The member has had no new bleeds since starting the new drug. Drug costs for the employer group have been reduced by nearly $4 million per year since the switch.
Treatment for hemophilia has come a long way
In the 1930s, some people with hemophilia were treated with diluted snake venom. In the late ‘50s, frozen plasma was transfused in the hospital. In the ‘70s, freeze-dried powdered concentrates containing factor could be stored to be self-infused at home.2
By the 1990s, using prophylaxis (preventive) factor treatment two or three times a week was helping many people with hemophilia lead regular lives.3
Today, the factor product category includes more than two dozen agents, with more in the pipeline. New treatments like these have lengthened life expectancy for people with hemophilia from just 20 years to near normal. And a potentially curative gene therapy treatment is currently in clinical trials. While these advancements are changing the lives of patients, today’s treatments still need to be affordable.4 And that means improving the quality of care while lowering costs. This case study shows that Prime knows how to do that.
1. Bowen K L, Gleason PP. 2012 Prevalence and Cost of Coagulation Factor Treatment for Hemophilia and von Willebrand’s Disease Among 10 Million Commercially Insured Members. J Manag Care Pharm 2013;19(8):655.
2. History of Bleeding Disorders. National Hemophilia Foundation. © 2018 National Hemophilia Foundation. Accessed at: https://www.hemophilia.org/Bleeding-Disorders/History-of-Bleeding-Disorders
3. Fast Facts. National Hemophilia Foundation. (n.d.) © 2018 National Hemophilia Foundation. Accessed April 1, 2018 at https://www.hemophilia.org/About-Us/Fast-Facts
4. Bowen K, Borchard M, Gleason PP. Incremental Cost of Switching to Extended Half-life (EHL) Coagulation Factor Products to Treat Hemophilia Among 15 Million Commercially Insured Members. April 2018. AMCP Boston, MA. Poster Presentation. https://www.primetherapeutics.com/content/dam/corporate/Documents/Newsroom/Pressreleases/2018/document-amcpspring18-hemophilia.pdf
About Prime Therapeutics
Prime Therapeutics LLC (Prime) makes health care work better by helping people get the medicine they need to feel better and live well. Prime provides total drug management solutions for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and offers clinical services for people with complex medical conditions. Prime serves more than 30 million people. It is collectively owned by 18 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans.
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