About 8% of the U.S. population has an autoimmune disease — a condition that causes the body’s immune system to mistakenly attack healthy cells, tissues or organs.  

There are more than 100 different kinds of autoimmune diseases, including multiple sclerosis, rheumatoid arthritis, lupus, psoriasis, inflammatory bowel disease and myasthenia gravis. These conditions are typically chronic, progressive and require long-term treatment with high-cost specialty medications. 

As new therapies and biologics — or medications derived from living sources used to target specific diseases — enter the market, pharmacy spend for autoimmune conditions continues to accelerate, placing pressure on payers, providers, employers and patients alike. For example, Novo Nordisk’s eculizumab (Soliris), used to treat myasthenia gravis, can reach more than $700,000 annually. Others, like Chiesi Group’s metreleptin (Myalept), used to treat lipodystrophy, can reach more than $1 million annually.  

Prime Therapeutics (Prime) is committed to making medications affordable for those with chronic conditions like autoimmune diseases. By using advanced analytics, clinical expertise and high-touch pharmacist outreach, Prime works with payers and providers to help address cost challenges while improving care.  

“Autoimmune conditions present a unique challenge for payers because the therapies are often lifelong, clinically complex and among the most expensive medications on the market,” said Pat Gleason, PharmD,  FCCP, FAMCP, assistant vice president of health outcomes at Prime. “By combining advanced analytics with integrated insights across the pharmacy and medical benefit, Prime helps payers anticipate where costs are headed, intervene earlier in the patient journey ensuring the most-cost effective drug therapy without adding unnecessary burden for patients or providers.” 

Autoimmune drug costs continue to climb 

Autoimmune conditions are seeing a number of new formulations, dosing strategies and administration routes, adding clinical complexity. Prime’s 2025 Spring Prime Therapeutics Report highlights how managing autoimmune conditions increasingly requires integrated oversight across benefits to help ensure therapies are clinically appropriate and cost effective.  

Prime works toward affordability through its HighTouchRx® solution. The platform applies advanced clinical rules and machine learning to integrated medical and pharmacy claims data to identify non-optimized drug use, including:  

• Duplicate or overlapping therapies 

• Dosing inefficiencies 

• Oversupply and refill timing issues 

• Brand to generic or biosimilar opportunities 

• Site of care and administration optimization 

“HighTouchRx keeps the patient experience front and center by combining personalized, pharmacist-led engagement with data-driven insights  — optimizing medications in ways that protect affordability, support clinical appropriateness, and minimize disruption to care,” said Marie Wimmer, director program capabilities.  

Since its launch, HighTouchRx has generated millions of dollars in total drug savings across commercial and Medicare plans, according to Prime data, with a growing share driven by autoimmune and immune-mediated conditions. 

Research demonstrates HighTouchRx’s impact 

A gold-award-winning study, presented at Academy of Managed Care Pharmacy (AMCP) Nexus, showed how targeted pharmacist outreach through the HighTouchRx program drove more than $10.3 million in savings for multiple sclerosis alone. By identifying opportunities to switch from brand-name drugs to clinically appropriate generics, Prime helped reduce unnecessary cost.  

“What’s most important about this research is that it translates analytics into real, actionable, hard-dollar savings opportunities,” said Nick Friedlander, PharmD, health outcomes researcher. “The findings demonstrate how programs like HighTouchRx can help payers identify non-optimized drug use, collaborate more effectively with prescribers, and manage rising specialty costs without disrupting the patient journey.” 

Additional AMCP research from Prime has shown that HighTouchRx interventions can reduce costs associated with immune mediated inflammatory therapies, such as dupilumab, by addressing oversupply and cumulative dosing issues through pharmacist to prescriber collaboration.  

Learn more about HighTouchRx