Autoimmune Diseases

2021 Q2 Rx Newsletter

May 5, 2021

Many autoimmune diseases can cause chronic inflammation such as Rheumatoid Arthritis (RA) and Plaque Psoriasis (PsO).

Here are some figures to keep in mind when considering autoimmune prevalence and costs:

• Humira is currently the number one specialty drug for inflammatory conditions.
• Cigna’s Evernorth division reported book of business spend on inflammatory conditions

    • increased 15.6% in 2020, driven by:
    • Increase of 4.5% in utilization
    • Increase of 11.1% in unit cost.
    • Specialty drugs accounted for nearly 95% of total spend for inflammatory conditions.
  • The CDC estimates 1.5 million people in the U.S. have been diagnosed with RA.
    • Women are three times more likely to be affected than men. RA can occur at any age, but is most common in adults in their 60s.
  • Annual total healthcare costs per each RA patient is estimated to range from $12,509 to $36,053, according to a recent CVS Health study.
  • The National Psoriasis Foundation estimates that over 8 million people in the U.S. have been diagnosed with PsO.
    • It is more common in adults than in children and affects men and women equally.
    • Roughly 25% of people diagnosed with PsO are considered moderate-to-severe.
  • Annual total healthcare costs per each PsO patient is estimated at $22,713, according to the American Journal of Managed Care.

Early, Aggressive Treatment Can Help

The primary goal of treatment related to inflammatory conditions is to gain control of the disease rather than cure. Currently, there is no cure for RA or PsO available. According to a recent CVS Health study, research shows that “addressing various factors such as a timely diagnosis, treatment or dispensing choices, and cost of disease management can also influence patient engagement.”

The costs associated with treatment for inflammatory conditions vary based on the progression of the inflammatory condition. The average cost per prescription for treating inflammatory conditions is $4,500, according to Evernorth’s 2020 Drug Trend report.

Some of the most common biologics used to treat inflammatory conditions include:

  • Adalimumab (Humira®)
  • Etanercept (Enbrel®)
  • Infliximab (Remicade®)

What Can Plan Sponsors Do?

Understanding the prevalence of inflammatory conditions and available treatment options can help employers determine which drugs should be covered and what utilization management (UM) strategies may be most effective in controlling costs related to inflammatory conditions. Incorporating more robust cost containment strategies like prior authorization, step therapy, limited supply programs that aim to reduce waste due to complications, and site-of-care solutions are viable opportunities for employers looking to control costs. Members diagnosed with RA and PsO can benefit from personalized, in-depth care management geared towards balancing access to treatment, improving medication adherence, reducing condition-related complications, and hopefully reduce the overall costs related to inflammatory conditions.