Prime Therapeutics finds $1.1 million waste reduction opportunity with medically integrated dispensing compared to central specialty pharmacy

Real-world findings reinforce patient benefits of care team, in-house pharmacy integration

June 2, 2022

EAGAN, Minn. – Leading pharmacy benefit manager (PBM) Prime Therapeutics LLC (Prime) analyzed its real-world data to assess clinical outcomes and drug waste differences between medically integrated dispensing (MID) and central specialty pharmacy dispensing of oral cancer therapies. This study of a Prime pilot program showed a potential average savings opportunity of $1,800 per medication dose change at a MID pharmacy compared to a central fill specialty pharmacy. Results reinforced Prime’s position of the advantages of the MID model, on which its IntegratedRx™ program is based.

“Since MID pharmacists and providers are collaborating within the same EMR in real time, the level of care coordination that they can achieve can’t be replicated in the central fill model,” said Joseph Leach, MD, senior vice president and chief medical officer for Prime. Leach, lead study author and practicing oncologist at Minnesota Oncology, added, “Our study confirms that this translates into better patient care and reduced cost through reduction in drug waste.”

With the MID model, care providers – including doctors and pharmacists – have access to prescribing history, test results and other important patient information in the EMR. This coordination informs the care team earlier than the traditional model. This early look has potential to help lower the number of 30-day prescriptions going to waste.

Prime’s MID pilot program was implemented in early 2021 within three oncology practices and across three Blue Plans’ commercially insured lives to prove the potential care and cost advantages with this distinct model compared to a centralized specialty pharmacy model. Study participants were prescribed oral drugs that did not require dispensing and shipment from a payer directed specialty pharmacy to the oncologist (aka white bagging).

Prime analyzed 627 pilot members over an eight-month period to identify MID medication adherence and discontinuation rate, dose changes and drug waste differences for 26 oral oncolytics.

Research findings include:

  • Waste – due to medication overfills – occurred in 29% of MID dose changes and 50% of central specialty pharmacy dose changes, resulting in an average cost of $937 and $2,733 per dose change at the MID and specialty pharmacy, respectively, for a specialty pharmacy average dose change additional cost of $1796.
  • That translates to an estimated savings of $1.1 million if all 627 individuals with a dose change had used a MID pharmacy, which represents a significant savings opportunity across Prime’s broader book of business.
  • The study also showed a significantly lower medication discontinuation rate with MID, and MID demonstrated a numerically higher adherence rate compared to central specialty pharmacy dispensing.

Leach added, “The specialty drug pipeline is bursting with oral oncolytics that will improve the lives of people with cancer. Prime and Blue Plans created our IntegratedRx™ – Oncology program to enable and encourage oncology practice dispensing with the goal of improving care, enhancing the provider and member experience, and reducing drug waste.”

As Prime expands its IntegratedRx™ program to encompass other disease states, it will continue to identify and implement waste reduction best practices related to medication overfills.

This study (e18645) was selected from more than 6,000 abstracts for online publication in conjunction with the American Society of Clinical Oncology (ASCO) Annual Meeting June 3-7, 2022, in Chicago, Ill.

 

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