Real-world findings helped in decision making to remove drug’s prior authorization
EAGAN, Minn., Oct. 20, 2020 /PRNewswire/ — Sacubitril-valsartan (Entresto®) has been proven to decrease hospitalization and reduce death due to heart failure with reduced ejection fraction (HFrEF) also known as systolic heart failure. 1 According to a recent study by Prime Therapeutics LLC (Prime), members adherent to Entresto therapy for a year had reduced medical visits and expenditures. Savings associated with those visits totaled $6.7 million when comparing costs after starting Entresto to prior costs.
Approximately 6.2 million adults in the U.S. have heart failure, according to the American Heart Association.2 The U.S. Food and Drug Administration (FDA) approved Entresto to treat HFrEF, This occurs when the heart’s left ventricle loses its ability to contract normally and the heart fails to pump with enough force to push needed blood levels into circulation.
Prime analyzed integrated medical and pharmacy claims data for 658 commercially-insured members who were adherent to Entresto. The study identified changes in total cost of care for these members – both medical and pharmacy costs, and occurrence of hospitalization and emergency room visits.
When comparing adherent members’ claims in the year-prior to the year-post analytic periods before and after starting Entresto, overall total cost of care decreased an average of $10,177
(-22.0%) for a cumulative $6.7 million in savings. Other findings (on average) include:
- hospitalizations decreased 63.3%,
- emergency room visits decreased 43.9%,
- office visits increased 4.8%,
- medical costs decreased $15,724 (-37.7%),
- hospitalization costs decreased $16,532 (-69.2%),
- emergency room costs decreased $163 to (-30.1),
- office visit costs increased $1,507 (13.3%), and
- pharmacy costs increased $5,547 (121.5%).
Additionally, the study analyzed both adherent and non-adherent members together. Researchers found a similar increase in pharmacy costs, but a much lower reduction in medical costs resulting in cost neutrality.
“Seeing a decrease in the majority of cost and care categories is exactly what we want to see for members,” said Patrick Gleason, PharmD, assistant vice president of health outcomes at Prime. “A slight trade off comes with an increase to pharmacy costs – as Entresto is more expensive than other treatments – but the overall total cost of care offset, in this real-world study is significant. We stand by our recommendation to health plans and self-insured employers to remove the Entresto prior authorization, encouraging use of this life-saving, cost-effective medication for HFrEF.”
An important part of the managed care pharmacy is to help ensure medication access and coverage of safe and cost-effective medications. For the drug Entresto, manufactured by Novartis, Prime negotiated a value-based contract that included total cost of care assurances that – in conjunction with published clinical guidelines – provided the impetus for prior authorization removal. “Eliminating the prior authorization fast-tracks member access to Entresto which can save lives and health care costs,” added Gleason.
This platinum award-winning research will be presented at the Academy of Managed Care Pharmacy (AMCP) Nexus 2020 Virtual event Oct. 19-23.
- McMurray J., et al. (2014). Angiotensin neprilysin inhibition versus enalapril in heart failure. N Engl J Med, 371:9931004.
- Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation. 2020;141(9):e139-596.
About Prime Therapeutics
Prime Therapeutics LLC (Prime) makes health care work better by helping people get the medicine they need to feel better and live well. Prime provides total drug management solutions for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and offers clinical services for people with complex medical conditions. Prime serves more than 30 million people. It is collectively owned by 18 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. For more information visit www.primetherapeutics.com or follow @Prime_PBM on Twitter.
CONTACT:
Denise Lecher
Public Relations Manager
612.777.5763
Denise.Lecher@primetherapeutics.com
SOURCE Prime Therapeutics LLC
