Prime Therapeutics and Magellan Rx to present eight managed care pharmacy research studies at AMCP

EAGAN, Minn. – Prime Therapeutics LLC/Magellan Rx Management, LLC (Prime/MRx) continues to publish award-winning and industry-leading research on a range of clinical topics impacting the health care and pharmacy benefit management industry. Thought leaders from Prime/MRx will present eight research studies at the Academy of Managed Care Pharmacy (AMCP) Annual Meeting, April 15–18 in New Orleans.

Health outcomes teams from the organization used integrated medical and pharmacy claims data to evaluate real-world drug utilization, managed care pharmacy programs and associated costs of care for a range of conditions, including weight loss, cardiovascular disease, cancer and multiple sclerosis.

“Prime/MRx health outcomes and clinical research enables our teams to access critical data that can lead to improved health outcomes and reduced health care costs,” said David Lassen, PharmD, chief clinical officer at Prime/MRx. “This research also demonstrates not only our ability to lead with insights that have an impact on our industry, but it’s at the nexus of our ability to reimagine pharmacy management to provide the same care we would want for our loved ones.”

The following studies will be featured at this year’s event:

Real-World Adherence and Persistence to Glucagon-Like Peptide-1 Receptor Agonists Among Non-Diabetic Obese Commercially Insured Adults

In July 2023, Prime/MRx announced its analysis of real-world integrated pharmacy and medical claims data of non-diabetic individuals who newly started glucagon-like peptide-1 (GLP-1) agonist drugs for weight loss. The analysis showed low adherence in the first year of their GLP-1 therapy. More details from the GLP-1 weight loss therapy adherence and persistence study are being presented at AMCP, and the work received a bronze award.

As noted in the previous study, among those taking GLP-1 drugs for weight loss with a diabetes diagnosis, after one year, the overall persistency across all products was 32%. Additionally, the highest and lowest persistency rates at one year were 47% for Ozepmic® (the weekly injectable semaglutide, which is FDA-approved for diabetes treatment) and at 19% for Saxenda® (the daily injection liraglutide, which is FDA-approved for weight loss), respectively. Persistency for Wegovy® (the FDA-approved weight loss semaglutide product) was 36%. Overall, 27% of members were adherent to their GLP-1 therapy for weight loss at one year. Low adherence and persistence among individuals may be due to adverse effects, lack of perceived benefit, member cost share, and drug shortages. While additional research is needed to understand reasons for discontinuation of treatment and long-term cost-effectiveness, it’s recommended that individuals taking GLP-1 drugs for weight loss do so as part of a comprehensive weight loss treatment program, which may improve therapy persistency.

Real-World First Year Cost-Effectiveness Assessment of Glucagon-Like Peptide-1 Agonists to Treat Non-Diabetes Obesity

The same real-world analysis from July 2023 also identified a substantial increase in health care cost in the first year among individuals who started GLP-1 drugs for weight loss without diabetes. The study, which provides further health care cost analysis details, will be presented at AMCP, and also is the recipient of a gold award.

The key finding is that health plans and self-insured employers can expect to incur a significant $7,132 total cost of care (TCC) investment at one year for each member newly initiating a GLP-1 for weight loss without a diabetes diagnosis. In addition, no medical cost offset was seen; instead, the GLP-1 treatment group was associated with an increased medical cost by $1,487 per person compared to a matched group. These findings also indicate that short-term TCC should not be expected from GLP-1 weight loss treatment, and instead GLP-1 weight loss treatment should be thought of as a long-term investment with yet unknown, long-term cost-effectiveness.

Obesity with Preexisting Cardiovascular Disease without Diabetes: Current Glucagon-Like Peptide-1 (GLP-1) Agonist Treatment Prevalence Among 16 Million Commercially Insured Members

While the use of GLP-1 drugs for weight loss has been a key concentration for recent Prime/MRx clinical and health outcomes research, Wegovy® also has been the focus of a recently published New England Journal of Medicine (NEJM) study. Known as the SELECT Study, it assessed the effect of Wegovy® on heart disease and stroke for patients with obesity and preexisting cardiovascular diseases (CVD), but without diabetes. Individuals who met these criteria were treated with Wegovy® for three years, and the study cited reduced “incidence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke.” These findings resulted in a new Wegovy® label, FDA-approved indication for CVD secondary prevention.

Using the NEJM SELECT Study as a model, Prime/MRx conducted a study and looked at its integrated pharmacy and medical claims data to determine GLP-1 treatment prevalence and future use potential among its members with obesity and CVD without diabetes.

Among 16 million commercially insured members, 1 in 100 members meet the SELECT Study criteria, and only 1 in 43 of these members are receiving GLP-1 treatment. If all untreated SELECT Study-qualifying members were to receive treatment, at a $10,000 annual GLP-1 cost per individual treated, Prime/MRx research indicates that it would be $9 in new per member per month (PMPM) expenditures. In other words, health plans and self-insured employers should plan for substantial new PMPM costs per the SELECT Study findings.

“From their use as a treatment for diabetes, to their applications in weight loss management, and now cardiovascular disease, GLP-1 drugs have taken the health care industry by storm,” Lassen said. “And while our real-world data so far indicates low adherence and increased cost of care specifically with GLP-1 drugs for weight loss, this data, and ongoing study, can best equip health plans as they seek ways to improve health outcomes and access to these drugs and reduce costs.”

For additional insights from Prime/MRx on GLP-1 drugs and solutions, visit our GLP-1 Strategy page.

Medically Integrated Dispensing of Oral Oncolytics: Real-World Cost of Care Comparison to Traditional Dispensing  

Medically integrated dispensing — which involves multidisciplinary care teams dispensing drugs with an in-house pharmacy or primary care facility — has been associated with better health outcomes, lower waste and better patient experience for those receiving oral oncolytics, a type of immunotherapy treatment for cancer. Prime/MRx offers medically integrated dispensing of oncolytics through IntegratedRx®.

This study compares the six-month, pre- and post-care between commercially insured members initiating oral oncolytic therapy via integrated and non-integrated dispensing channels to determine TCC between them. After identifying members newly beginning an oral oncolytic drug therapy, using the 16 million commercially insured Prime Therapeutics integrated pharmacy and medical claims database, researchers found that oncology drug dispensing through IntegratedRx® was associated with 9.4% lower medical cost and 4.8% lower TCC compared to the traditional oral oncolytic dispensing channel.

Medication Nonadherence Social Determinants of Health Risk Score: Development and Use

Social determinants of health (SDOH) — or the conditions in a person’s environment that affect health, function and quality-of-life outcomes and risks — contribute to as much as 80% of variation in health outcomes.

To support SDOH-related care management efforts, Prime/MRx researchers sought to develop a prioritization score of Medicare members at risk of SDOH-related medication nonadherence. Using data from 2022 pharmacy claims for adherence measure-eligible members enrolled in 65 Medicare Advantage and Part D (MAPD and PDP) plans, researchers created a single score representing a member’s percentage point likelihood of SDOH-related medication nonadherence.

The study demonstrates the feasibility of combining many different types of SDOH-related data into a single summary score to be used by pharmacists’ and pharmacies’ care management services to support MAPD and PDP plan sponsors’ efforts in response to Medicare’s SDOH-related initiatives.

Promoting Generic Multiple Sclerosis Drug Utilization and Drug Cost Savings with a Managed Care Pharmacist Outreach Program

A number of generic multiple sclerosis (MS) medications supported by the American Academy of Neurology have recently become more widely available, improving drug therapy access. Managed care pharmacists (MCP) aid in transitioning to generic therapy, reducing total drug spend and member cost. Prime/MRx sought to assess the outcomes and financial impact of a brand-to-generic program targeting MS therapies using an MCP-facing web application tool, facilitating pharmacist-to-provider or pharmacist-to-pharmacist outreach. This study is the recipient of a gold award.

Prime/MRx researchers examined six months of pharmacy claims history to identify members who recently utilized a brand-name MS drug for which a cost-saving generic exists. Out of 778 cases, 16% resulted in a successful transition to lower-cost generic therapies, resulting in $10 million validated savings, with an additional $3 million savings potential among in-progress cases. The research found that using an MCP-facing web application tool facilitating pharmacist outreach can aid in transitioning to generic therapy, reducing total drug spend and member cost.

Prime/MRx residents also will present two additional research studies, “Retrospective Claims Analysis of Opioid Prescribing Patterns: Single and Combination Agents for Acute Pain and Subsequent Conversion to Chronic Opioid Usage Among Commercial Members,” and “Real-World Utilization Differences Between SGLT2 Inhibitors and GLP-1 Receptor Agonists Post Metformin Monotherapy.”

In addition, Prime/MRx researchers will share their insights and participate in several sessions during AMCP Annual. More information about these presentations can be found on the Prime/MRx events page or the AMCP Annual website.