In an exclusive interview with PharmaShots, Kelly Pokuta, Vice President of Pharmaceutical Trade Relations, and April Kunze, Senior Director, Clinical Formulary Development & Trend Management Strategy at Prime therapeutics share their views on the MedDrive as a first-of-its-kind medical drug management program uniquely aligned with its Blue Plan clients.
- Prime introduced the first-of-its-kind medical drug management solution with an aligned approach to drive down costs for high-cost specialty drugs that now make up more than 50% of total drug costs
- The MedDrive program will be launched in multiple phases. The first phase focuses on drug savings strategies through greater biosimilar drug adoption. Other elements include benefit designs that prefer lowest net cost non-biosimilar drugs with enhancements to predictive data analytics, medical sourcing opportunities, and consultation services
- MedDrive will tackle the toughest challenges facing growing medical Rx drug spend, harnessing the savings in biosimilars
Tuba: What is the main concern of this new medical drug management program? What are your beliefs regarding this program?
April Kunze: There are many new products coming to market to treat novel conditions and many additional products being approved, creating opportunities for preferred product strategies on the medical benefit. The rise in drug spending in medical creates an opportunity to more closely evaluate drug coverage and assure appropriate use and encourage low-cost therapies.
Kelly Pokuta: Prime is in a unique position to work with our Blues Plans to truly integrate data and drug coverage across benefits and manage total drug spend. Total drug management is how we’re truly going to get a handle on rising drug prices. Yet today, managing both pharmacy and medical drug spend is a challenge for most in the industry due to a lack of integration. Prime receives both pharmacy and medical drug claims data making this strategy possible for our clients to achieve. This new offering by Prime Therapeutics is the first program that aligns market-leading health plans to leverage market share and drive savings. This puts Prime in the unique position to deliver fully transparent total drug management solutions.
Tuba: As drug prices are a major concern for many Americans, how the MedDrive will help Blue Plan clients?
April Kunze: Rising drug costs are a big part of today’s health care crisis. According to data from the IQVIA Institute as noted in this Forbes article (2018), biologic drugs have accounted for nearly all (93%) of the net drug spending growth since 2014. The more plans come together around the interchangeability of biosimilars and prefer the lower cost options instead of high-cost reference brand biologics, the more they can obtain market-leading savings. These savings can help hold down premium costs for their members. Aligning our Blues also helps create a cohesive message for members and providers across the health plans and alignment provides more value in general.
Tuba: How this program is different and what motivates you to work on medical drug management strategies?
April Kunze: Again, this new offering is the first program that aligns market-leading health plans to leverage market share and drive savings, which, puts Prime in the unique position to deliver fully transparent total drug management solutions. It’s also different in that it’ll also be bringing key parts of the health care industry together – such as providers, specialty pharmacies, and manufacturers – to help ensure biosimilars are accepted and used as equally safe and effective treatments so people can benefit from the most appropriate drug at the lowest net cost drug. Given Prime’s vast experience in evaluating drugs clinically and evaluating appropriate use for both clinical & financial reasons, we are well-positioned with our Blues to provide consultative services to help them better manage their medical drug spend. In addition, aligning strategies across our Blues helps to strengthen their position in managing to low net cost products.
Kelly Pokuta: Prime is also evaluating additional programs and services that will roll up under MedDrive and more information will be available at a future time.
Tuba: Highlight the key features of MedDrive? Discuss the importance of this program for patients as wells as HCPs.
Kelly Pokuta: MedDrive combines Prime’s medical drug management solutions all in one product to help our health plan clients manage costly medicines and align to help realize these savings. Prime is harnessing the collective strength of Blue Plan alignment on preferred drug lists to drive to the lowest cost drug options, including preferring biosimilars when it helps members and plans get the right drug at the lowest possible cost. MedDrive also includes other market-leading cost-saving strategies supported by analytics and reporting, such as medical policies and clinical tools, consultative services to navigate the growing specialty landscape, provider and member education and support, and more.
April Kunze: MedDrive is important to patients and health care providers in that clinically appropriate drugs are selected for preferred coverage, ensuring that the member’s health is not compromised. Our positions are reviewed by our National P&T Committee, comprised of clinicians practicing throughout the nation and across many specialties.
Kelly Pokuta: Prime recognizes the importance of the provider to deliver high-quality care and the need for cost-efficient options to manage a patient’s out-of-pocket expense. Providing quality solutions that improve affordability is a key focus of MedDrive.
Tuba: What are the different phases of MedDrive program?
Kelly Pokuta: The first phase (described above) is underway, but timing varies by program and client. Some clients can implement as early as 7/1/21 or anytime thereafter. Additionally, state-specific requirements on notification of changes may impact implementation timing. We expect the first phase to take approximately through 2021. We are in the planning process for the second and subsequent phases at this time, but we will add more tools to the MedDrive toolkit as the program expands. Prime will continue to build the MedDrive offering s and more information will become available in the near future.
Tuba: How does biosimilars adoption leads to savings while offering patients safe and effective treatments?
Implementing MedDrive is a multi-year strategy for our clients and the biosimilars as a cost savings driver is key. We expect that medical drug management strategies, such as maximizing medical savings and preferring biosimilars, can lead to hundreds of millions if not billions of dollars in medical drug savings for health plans over 5 years. In fact, Prime has been achieving success with biosimilars already as we tested these strategies with a few clients in advance of launching MedDrive. In the oncology class, one client shifted the use of biosimilars from single digits (0%-25%) to 80-90% and saved several hundreds of millions of dollars and overall PMPM savings. If all clients adopted this strategy savings would be considerable.
Tuba: Let us know about the key points of the report given by IQVIA on biosimilars?
We can’t speak for them, however, here is a link to IQVIA’s 2020 report so you can review: https://www.iqvia.com/insights/the-iqvia-institute/reports/biosimilars-in-the-united-states-2020-2024
What we found most interesting was the statement “Though savings from biosimilars had been slow to build, recently-launched biosimilars have achieved significant uptake within their first year, and the availability and use of biosimilar medicines are on track to reduce drug costs by $100 billion over the next five years.” Additionally, this key point was of interest: “The three most recent biosimilar launches are set to reach nearly 60% shares of volume by the end of their second year on the market — significantly higher and faster than prior biosimilars.” This reflects the growing trend of utilizing biosimilars across many different disease states. More and more groups are releasing statements supporting biosimilar use which is also helpful in supporting this trend.
Tuba: Unveil the key points of the collaboration signed between Prime Therapeutics and Blue Plans.
MedDrive is a new product Prime is offering to its Blue Plan clients, not a separate contract they need to sign with us. Clients interested in helping to drive down the costs of drugs will be working with Prime to deploy many of the approaches this product offers. A few plan clients have already been testing out some of the biosimilar strategies and are seeing success. (See response to Q6.) plus these specific drug examples include:
- Prime recommended moving from Avastin to biosimilars (Mvasi and Zirabev). Six months after adopting the strategy, the client achieved total biosimilar market share greater than 90% (up from 25% and 2% respectively)
- Prime recommended moving from Herceptin to biosimilars (Kanjinti and Trazimera). Six months after adopting the strategy, the client achieved total biosimilar market share greater than 90% (up from 23% and 1% respectively)
- Prime recommended moving from Rituxan to biosimilars (Riabni and Ruxience). Six months after adopting the strategy, the client achieved total biosimilar market share greater than 80% (up from 0% and 2% respectively)
Leveraging best practices between our clients is a key driver for MedDrive’s success.
Another study just out by the Biosimilar Forum, a non-profit organization that advocates the use of biosimilars in the United States, might be of interest to you. Forbes wrote in a June 18, 2021 story saying “recent report shows that biosimilars played a significant role in lowering the prices of biological treatments for disease by an average of 56% and up to 150%. If it were not for these biosimilars, the number of patients could access these medicines would be limited, the report concludes.” “A crucial element to the role of biosimilars, the report found, is that they are not only less expensive than brand name biologics themselves, they also apply competitive pressure to the brand name drugs. The result is that those brand name biologics also keep their prices down.” “It is clear, especially with the results of this report, that biosimilar competition lowers drug prices,” said Meaghan Rose Smith, Executive Director of the Biosimilars Forum, in a press release. “As the next generation of generics, biosimilars have the potential to significantly save patients and taxpayers money, and increase access to life-saving treatment options.”
Prime agrees with the findings of this report and it illustrates what we’re seeing in the biosimilar space: more competition leads to better pricing and manufacturer savings we can leverage for our clients.
About Kelly Pokuta:
Kelly Pokuta is the Vice President of Pharmaceutical Trade Relations at Prime Therapeutics.
About April Kunze:
April Kunze is the Senior Director, Clinical Formulary Development & Trend Management Strategy at Prime Therapeutics