Imbruvica-Changing tablets to capsules

This patient was taking a formulation of a drug in tablet form that cost three times more than the same drug in capsule form.

August 27, 2020

Insights+ helped identify a patient who was taking a formulation of a drug in tablet form that cost three times more than the same drug in capsule form.  This discovery led to the creation of an upstream utilization management strategy that could save Blue Plan clients millions of dollars a year.

Brand-name drug manufacturers use various pricing strategies for their products based on dosing strengths and formulations. Understanding these nuances helps Prime identify the most cost-effective ways to use a drug, especially costly specialty drugs.

For example, a patient was prescribed Imbruvica® (ibrutinib) tablets. This is a targeted therapy for treating cancer.  As a result of the manufacturer’s pricing strategy, ibrutinib tablets costs three times as much as the same dosage of ibrutinib capsules. At the time, there was no drug management control in place to guide the doctor to select the lower cost capsules. Those controls are important. Prescribers can be unaware of the big cost ranges resulting from different dosing regimens and formulations of the same product.¹

Insights+ showed that the $12,000 monthly charge for the tablets was in sharp contrast to the $4,000 monthly charge for the capsules.

Path to savings for patient on ImbruvicaThis was identified as a large savings opportunity; the tablet form of Imbruvica costs three times as much as the capsules for the same dosage (140mg).

Prime developed a UM program that helps direct prescribing to the lower cost capsules to maximize savings.

The Blue Plan adopted Prime’s recommended UM to drive new patients to the lower cost capsule formulation. The plan also used a program that reached out to ask providers to switch any current patients taking tablets to the capsule form. This simple change meant the same drug, given at the same dose — but in a different oral form — produced the same therapeutic results at a big savings.

That’s just one way Prime uses integrated data to deliver maximized value for our clients.

Insights+ is Prime’s total drug management tool that leverages the industry-leading Artemetrx data and analytics platform. It aggregates specialty medical and pharmacy claims data and uses it to identify patterns of high-cost drug use, cost and waste in the health care delivery chain. Prime is the only pharmacy benefit manager offering insights in the form of comprehensive benefits data that can be filtered and reported in ways to suit payer needs.

Insights+ reduces the complexity of managing specialty pharmacy costs. This lets health plans focus more on their members.