Professional Documents
Culture Documents
T
he step therapy requirement for adalimumab cov- adalimumab in the first quarter of 2012, followed by a
erage does not lead to increased cost to the health paid claim for a step-1 agent within 30 days. The mem-
plan or increased utilization, according to a retro- bers in the control group (who were not affected by the
spective claims-based study by Kyle Burcher, PharmD, program) had a paid claim for adalimumab during the
UnitedHealthcare Pharmacy, Minnetonka, MN, and same time. Members in the 95th to 100th percentile by
colleagues from UnitedHealthcare and OptumInsight. total cost were removed from the analysis to mitigate the
They presented their data at the 2013 annual meeting of impact of outliers.
the Academy of Managed Care Pharmacy.1 Psoriasis was the most frequent (26%) diagnosis in
Biologic agents have been a top driver of pharmacy the study sample, followed by rheumatoid arthritis
costs over the past decade, a trend that is likely to con- (22%). Approximately 25% of the sample members had
tinue in the future, according to Dr Burcher and col- multiple diagnoses. The mean Charlson comorbidity
leagues. The lack of head-to-head trials showing superi- indices were 0.50 in the intervention group and 0.52 in
ority of one biologic agent over another in terms of the control group.
outcomes has created opportunities for health plans to
implement utilization management programs to control Economic and Health Impact
cost while maintaining access to current therapies. In the 180 days before the index claim, no significant
UnitedHealthcare introduced a step therapy program difference was evident between the 2 groups in mean
in 2012 for the treatment of rheumatoid arthritis, psori- medical cost, but the mean pharmacy cost was signifi-
atic arthritis, psoriasis, ankylosing spondylitis, and cantly higher in the intervention group compared with
Crohns disease. The program requires that member the control group$1343.32 versus $847.76 (P = .005).
prescribers first try 1 or more of the step-1 self-adminis- The mean medical costs during the 180 days after the
tered biologic anti-inflammatory agents included in the index claim were $3233.18 in the intervention group versus
programcertolizumab, etanercept, golimumab, and $2874.99 in the control group, a nonsignificant difference.
ustekinumabbefore UnitedHealthcare would provide All secondary end points were also not significantly
coverage for the use of adalimumab. different between the 2 groups. In the intervention group,
the mean number of pharmacy claims for nonbiologic
The mean medical costs during the 180 days disease-related therapies (ie, nonsteroidal anti-inflamma-
tory drugs, corticosteroids, and immunosuppressants) was
after the index claim were $3233.18 in the
3.38 compared with 2.98 in the control group (P = .821);
inserv
COLLECT DATE:
control group, a nonsignificant difference. 8.50, respectively (P = .276); and the percentage of mem-
Jeff Day
Dr Burcher and colleagues compared the health and ed increases in medical utilization and cost, suggested
cost utilization outcomes of 149 members in the inter- Dr Burcher and colleagues. n
PUB: AAAI
The intervention group had a step therapy edit for April 3-5, 2013; San Diego, CA.
AD
|I|N|G| |S|T|A|G|E
N: Mechanicals
CW
184 l American Health & Drug Benefits l www.AHDBonline.com May/June 2013 l Vol 6, No 4
EYEPP
011