Some companies that analyze specialty drug spend do so with a focus solely on the pharmacy benefit. This approach, however, may fail to take into account a significant amount of medical benefit spending within certain conditions, including inflammatory diseases. A recent study by Prime Therapeutics LLC revealed trends across both benefits for the conditions, which account for almost 20% of all pharmacy and medical benefit drug expenditures among Prime’s commercially insured book of business. It also demonstrated that the class may benefit from indication-based pricing.
The study was presented at the Academy of Managed Care Pharmacy’s AMCP 2021 virtual conference in April.