At the Academy of Managed Care Pharmacy’s Managed Care & Specialty Pharmacy Annual Meeting, experts addressed the cost of treating patients with hemophilia and the importance of care coordination to ensure a more holistic approach toward caring for these patients.
Hemophilia affects approximately 13 out of every 100,000 lives. “Looking at this through the lens of a payer, we know that hemophilia is a rare disease. It’s also a very expensive disease,” said Sam Leo, PharmD, director, specialty clinical programs, Magellan Rx management, during a session at the Academy of Managed Care Pharmacy’s Managed Care & Specialty Pharmacy Annual Meeting held April 23-26, in Boston, Massachusetts.
He continued: “Even though it’s a rare disease, it’s common enough that most groups are going to be dealing with hemophilia patients in their network.”
Leo began the presentation by explaining that when classifying patients with hemophilia, there are several differentiators. First, you can classify them based on their factor deficiency—whether they have hemophilia A or hemophilia B. He noted that hemophilia A is 4 times more common than hemophilia B. Patients can also be classified on their disease severity, whether it be mild (about 25% of patients), moderate (about 15% of patients), or severe (about 60% of patients).
These factors play a key role in how these patients are treated, said Leo. Patients with severe disease are those who are at the highest risk for spontaneous bleeds, therefore they are utilizing prophylaxis factor replacement therapy and are associated with the highest costs.
The last differentiator is patients with inhibitors. According to Leo, 20%-35% of patients develop antibodies that reduce the efficacy of replacement products, leaving them with less treatment options and thus are more complex to treat.
Leo then moved on to the current treatment landscape for the disease. “One thing we can certainly say is we don’t have a limited number of products to choose from,” said Leo. Currently, there are 48 drugs on the market, compared to just 1 that was available 40 years ago.
“A patient born today with hemophilia, due to the treatment options available, if they’re treated appropriately, can live to a normal life span, and that’s completely reflective of some of these changes in treatment and drugs we have to treat these patients,” said Leo. However, Leo did note that despite the amount of treatment options and competition, treatment costs remain high.
For a patient with hemophilia A, the annual cost of treatment ranges from $59,101 for those with mild disease to $301,392 for patients with severe disease receiving prophylaxis. For a patient with hemophilia B, the cost of treatment ranges from $85,852 to $263,253. According to Leo, factor replacement products represent up to 94% of total costs for patients with severe disease.
In addition to addressing high treatment costs, there are also management challenges that payers face, including:
Gary Tereso, PharmD, senior clinical pharmacist, Health New England continued the presentation with current management strategies, which include:
Tereso concluded the presentation with several future considerations. He underscored the importance of data collection and analysis in order to determine benchmarks and measure relevant outcomes, as well as collaborating with local centers of excellence under pre-agreed upon standards of care and data sharing arrangements to prevent the need for prior authorization. Tereso also highlighted holistic care and coordination of care, citing the need to consider the whole patient, not just the disease.
Bringing Connectivity to the Specialty Pharmacy Workflow
May 2nd 2024In a session during the final full day of conference activity at AXS24, experts from CVS Health and Surescripts emphasized the need to simplify the prescribing workflow for specialty medication through proactive messaging, automation, and interoperability.
Read More
Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
Listen
Specialty Pharmacists at the Forefront: Elevating Care for Rare Diseases
May 1st 2024In the US, a disease is considered rare when it affects fewer than 200,000 persons, or 1 in every 1500 individuals, with an estimated total of 25 to 30 million Americans overall living with a rare disease at any given time.
Read More
Latest Advances and Updates of Treatment in the Real World at AUA
May 1st 2024The annual meeting of the American Urological Association (AUA) not only presents the newest therapies coming out but showcases the latest in how treatments are being used in the real world, said Stephen Freedland, MD, of Cedars Sinai.
Read More