Analytics show super spenders account for nearly 10% of total drug spend

Studies on members with drug costs over $250,000 yield predictive modeling data

February 21, 2021

Ongoing studies using integrated benefits data on drug super spenders – members with total drug costs over $250,000 a year – provide predictive modeling data that can help manage outcomes and control costs

Ongoing studies using integrated benefits data on drug super spenders – members with total drug costs over $250,000 a year – provide predictive modeling data that can help manage outcomes and control costs

For many specialty conditions, nearly 90% of the total cost of care can come from drugs. That’s why Prime’s expertise at drug management is so important in controlling costs.

This study categorized and described trends in the medical conditions accounting for these member’s extraordinary drug expense.

This study contributes to Prime’s understanding of which drugs, conditions, and other factors can result in drug super spenders. It contributes to Prime’s ability to identify such members early by predictive modeling, and strategies to improve management of high cost specialty drugs. Integrated pharmacy claims analysis helps to confirm effectiveness of clinical programs and to identify additional opportunities.

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2016 to 2019 Trend in Integrated Total Pharmacy Plus Medical Benefit Drug Spend—Doubling of Members with Extremely High Annual Drug Cost within a 17 Million Commercially Insured Population (Spring 2020)
Drug Super Spenders: 2016 to 2018 Growth in Number of Members and Total Pharmacy Plus Medical Benefit Drug Cost for Members with Extremely High Annual Drug Cost in a 17 Million Member Commercially Insured Population (Fall 2019)

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