Prime Insights


Nov. 11, 2016 | Prime Therapeutics

Infographic: Drug pipeline profile: Duchenne muscular dystrophy

New  therapies for this rare disease are in pipeline, and they could have a big impact on drug costs — up to $4.57 per member per year.

DMD and what’s on the horizon

Nov. 8, 2016 | Prime Therapeutics

Managing accelerating autoimmune drugs costs across benefits is critical

Prime’s pharmacist researchers studied integrated trends in autoimmune drug use and spend, and presented their findings at the Academy of Managed Care Pharmacy (AMCP) 2016 Nexus event. Get the highlights — and learn what plan sponsors can do.

Trends in autoimmune

March 7, 2016 | Patrick Gleason

Coupons prove costly across the health system

Higher costs are probably the last thing that comes to mind when most people think of coupons. For insurers and pharmacy benefit managers (PBMs), however, coupons used on non-preferred drugs are contributing to escalating health care costs. That’s why I focused on this topic for my presentation at the annual the specialty-focused conference of the Pharmaceutical Management Association’s (sPCMA) conference on Feb. 8, 2016.

Presentation recap

March 14, 2016 | Steven Johnson

“No” isn't the answer to managing specialty drug costs

Saying “no” to expensive specialty drug claims isn’t the best way to control costs. Instead, saying “yes” — to the right drug, the right person and the right channel by using the right drug management tools — is the most effective strategy. That’s the message I delivered to industry leaders at the Pharmacy Benefit Management Institute’s (PBMI’s) recent Drug Benefit Conference.

Presentation recap

Nov. 11, 2015 | Kevin Bowen

Beyond PSCK9 prices: How valuable is coronary heart disease event prevention? 

With prices topping $14,000 per patient, per year, PSCK9 inhibitors have been dominating the headlines. But proactively managing care is just as important to controlling costs. When members who could benefit from cholesterol-lowering drug therapy aren’t being treated optimally, or at all, they’re at greater risk for costly coronary heart disease events.

Study analysis

Nov. 9, 2015 | Patrick Gleason

Another specialty blockbuster takes off: Analyzing Ibrance use, cost post-approval

The U.S. Food and Drug Administration (FDA) approved Ibrance in February 2015 to treat a certain type of breast cancer in postmenopausal women. At a cost of $476 per capsule, this latest specialty blockbuster has the potential to increase pharmacy costs for all stakeholders — not just people facing breast cancer. To learn what impact Ibrance could have on pharmacy benefit costs, our research team analyzed claims data from 18.6 million commercial and Medicare members. 

Study analysis

Feb 24, 2015 | Prime Therapeutics

REPORT: The economic viability of a U.S. biosimilars industry

A new report sponsored by Prime Therapeutics and authored by health economist Alex Brill suggests the market for biosimilars may not be as robust as many hope it will be. Unlike generic drugs, which significantly impacted the traditional pharmacy market with their cost savings, biosimilars face a number of hurdles.

Report summary | Full report

Prime Therapeutics | Oct. 15, 2015

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

Can out-of-pocket costs and pharmacy choice for blockbuster hepatitis C medicines significantly impact adherence and abandonment rates? 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 and those who used other specialty pharmacies.

Study analysis

July 21, 2015 | Prime Therapeutics

As high-cost cholesterol drugs loom, study finds statins underused

To determine appropriate coverage of the new PCSK9 inhibitors drugs, Prime analyzed its claims data and confirmed current statin treatments were not being used or adhered to as guidelines recommend. Adherence to statins is a long-standing national problem which is well studied and documented. Not surprisingly, Prime’s analysis validates there is a significant opportunity to optimize statin use even for members who may be eligible for PCSK9s.

Study analysis

June 17, 2015 | Prime Therapeutics

Drug Watch List debuts online

You can now access Prime's Drug Watch List online. The list identifies potential blockbuster drugs and projects potential financial impacts. The list — which we’ll update monthly — provides early, actionable intelligence about the use and financial impact of high-cost drugs awaiting U.S. Food and Drug Administration (FDA) approval.

Drug Watch List

Feb. 3, 2014 | Prime Therapeutics

Study finds lower cost of care and improved adherence with Prime Specialty Pharmacy

Generally, members who stick to their specialty drug regimens are likely to have lower cost of care due to fewer complications and doctor visits. Prime strives to keep members adherent through an effective and efficient care management program, offering services beyond what they would receive in a standard pharmacy. In a separate study, specialty drug adherence was found to be higher among members using Prime Specialty Pharmacy compared to a standard retail pharmacy.

Study analysis

Oct. 10, 2014 | Prime Therapeutics

Prime research featured in Health Affairs

The October 2014 edition of Health Affairs is dedicated to Specialty Pharmaceutical Spending and Policy. Prime's article in this issue is titled "Specialty Drug Coupons Lower Out-Of-Pocket Costs and May Improve Adherence At The Risk Of Increasing Premiums.” It examines insurers’ role in maintaining the affordability and accessibility of specialty drugs while maximizing their value.

Study coverage

Sept. 29, 2014 | Prime Therapeutics

Award-winning research to be presented

This October, Prime’s clinical research team will present findings from four studies at the fall meeting of the Academy of Managed Care Pharmacy (AMCP) in Boston. Two of Prime’s submissions are Platinum-level award winners. Instead of the traditional poster presentation, these two studies will be shared during a special educational session.

Poster session summary

June 17, 2014 | Prime Therapeutics

INFOGRAPHIC: Spotlight on specialty

Spending on specialty medicines is growing quickly. Prime projects that ten years from today, these high-cost medicines could represent one quarter of all health care costs. How much do you know about these drugs? Our new infographic can quickly get you up to speed. 


June 9, 2014 | Prime Therapeutics

Prime's insights take an international stage

Passports in hand, Prime’s clinical researchers departed last week for the 19th annual meeting of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Prime’s team presented two studies, offeringnew insights on the important topics of specialty pharmacy costs and medication adherence:

  • Understanding the pharmacy costs related to treating breast cancer
  • Assessing the impact of provider mailings on medication adherence in the Medicare Part D population

Poster session summary

May 21, 2014 | Patrick Gleason

Study finds using Prime Specialty Pharmacy may help reduce total health care costs

For chronically ill people, high health care expenses are just one more burden brought on by the disease. A new study suggests that using Prime Specialty Pharmacy may help lighten that burden.

Study analysis

April 7, 2014 | Patrick Gleason

Custom care can help specialty members stay the course

Members on specialty drugs often have complex and costly drug regimens. Prime Specialty Pharmacy offers a number of high-touch services designed to improve the quality of care for these individuals. This analysis suggests that providing members with services beyond what they receive at retail – such as benefits coordination, customized care, and payment assistance – is important to helping them stay on their medicines.

Study analysis

April 4, 2014 | Patrick Gleason

What does $250 buy? More appropriate drug use

Nearly one third of all initial drug prescriptions were not filled within 9 months. Nonadherence was highest for expensive drugs and chronic preventive therapies. Prime’s clinical outcomes team studied this problem in two specialty drug categories: multiple sclerosis (MS) and biologic anti-inflammatory (BAI) drugs used to treat conditions like rheumatoid arthritis, psoriasis and Crohn’s disease. We found that members who paid less than $250 out-of-pocket were much more likely to start MS or BAI therapy. 

Study analysis

March 28, 2014 | Prime Therapeutics

Presenting new pharmacy insights

Prime’s clinical research team will present findings from four studies:

  • Out-of-pocket costs and specialty prescription abandonment
  • Using member characteristics and costs to identify potential high-risk opioid use
  • Results of pharmacist consultation aimed at preventing opioid overutilization
  • Specialty drug adherence at Prime Specialty Pharmacy versus retail pharmacy

Poster session summary

March 27, 2014 | David Lassen

A potential $1.5 million pharmacy bill prompts collaborative investigation

The call came from one of Prime’s clients. A pharmacy director noticed something strange on a report. One of their members — had specialty pharmacy claims adding up to approximately $129,000 within just one month. Something wasn’t right. Both Prime and the Blue Plan looked into the situation. 

Case study

Feb. 4, 2014 | Patrick Gleason

A year-long look at copay offset efforts and results

Early in 2013, the health outcomes research team at Prime began measuring the effect of “copay offsets” – the use of manufacturer coupons and patient assistance programs to reduce members’ specialty drug costs. My colleague, Shelley Sánchez, and I have prepared an update on our efforts to help make specialty drugs more affordable – and why we think this is so important for people who take specialty medicines.

Study analysis

Jan. 20, 2014 | Kevin Bowen

Integrated analysis of current HER2 chemotherapy helps in estimating future costs

Our health outcomes team studied claims data for members from 11 health plans to determine recent use of Herceptin. We estimated the number of members who will be started on chemotherapy for early stage breast cancer each year along with the percentage of these members who will be treated with anti-HER2 drugs.

Study analysis