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Prime Therapeutics Specialty Pharmacy helped nearly 20,000 members save $21.2 million on specialty medicines in 2013

Copay offsets-coupons and patient assistance programs-assist members with high-cost medicine

ST. PAUL, Minn., Feb. 4, 2014 /PRNewswire/ -- Prime Therapeutics LLC (Prime), a leading pharmacy benefit manager, helped nearly 20,000 members save more than $21.2 million on high-cost, specialty medicines in 2013 by helping members secure specialty copay offset programs. These copay offsets – mainly manufacturers' coupons and patient assistance programs (PAPs) – are one way Prime helps to lower out of pocket costs for members. Prime's researchers will present these findings at Pharmacy Benefit Management Institute's (PBMI) 2014 conference, Feb. 3-5 in Las Vegas.

With specialty drug costs expected to rise to 50 percent of commercially insured total drug costs by 2018, Prime Therapeutics Specialty Pharmacy LLC (Prime Specialty Pharmacy) helps health plans, employers and members control costs and manage complex health conditions such as cancer, rheumatoid arthritis and multiple sclerosis. In addition to offering a full suite of specialty pharmacy services, including delivery of specialty medicines, care management, and insurance billing, it also works to make medicine more affordable for its members and the health plans it serves.

Copay coupons and PAPs are offered by pharmaceutical manufacturers to help patients defray the cost of drug treatments and help maintain member adherence. According to a September article in New England Journal of Medicine, nearly 400 traditional and specialty drugs offer a coupon for payment assistance. Additionally, 62 percent of these coupons were for brand-name medicines that had lower-cost therapeutic alternatives available.

"Copay coupons can be inappropriate for many medicines when there are low cost generic alternatives often available," said Pat Gleason, PharmD, BCPS, FCCP, director of health outcomes for Prime. "However, coupons can be vitally important for specialty medicines due to the high cost and lack of generic options."

Until now, little was known about these copay offset programs, since data on coupon and PAP use are frequently not collected by pharmacy benefit managers. However, Prime recently studied 264,801 Prime Specialty Pharmacy prescription claims for 37,890 members with prescriptions totaling $911,779,674. The following results showed applying copay offset programs had a significant impact:

  • Prime Specialty Pharmacy helped 19,862 members (52.4%) save $21,234,246 through copay offsets (manufacturer coupons and patient assistance programs - PAPs)
  • The savings of $21,234,246 represents 60.2% of the member share (originally $35,297,162)
  • 44.3% of the prescriptions (117,330 claims) had a copay offset applied to the member share.
  • The average yearly savings per member who received copay offsets was $1,069 (of the 19,862 members, for all their prescriptions through Prime Specialty Pharmacy during 2013)
    • $80 in copay offset savings per all prescriptions dispensed from Prime Specialty Pharmacy in 2013
    • $181 in copay offset savings per prescriptions dispensed from Prime Specialty Pharmacy where a copay offset was applied
    • >$1,000 copay offset savings was found in 4,893 (4.2%) of Prime Specialty Pharmacy prescriptions dispensed with any copay offset

"Helping members take advantage of these cost-reducing measures is critical because the high cost of specialty medicines has been shown to negatively affect members' adherence to their medicines," noted Gleason. "Applying copay offsets is just one of the many ways we help members get the medicines they need to feel better and live well."

About Prime Therapeutics
Prime Therapeutics LLC (Prime) helps people get the medicine they need to feel better and live well. Prime manages pharmacy benefits for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and delivers medicine to members, offering clinical services for people with complex medical conditions. Headquartered in St. Paul, Minn., Prime serves nearly 25 million people. It is collectively owned by 13 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. Prime has been recognized by Modern Healthcare as one of "healthcare's hottest companies for 2013." 

For more information, visit www.primetherapeutics.com  or follow @Prime_PBM on Twitter.

SOURCE Prime Therapeutics LLC

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