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Jan. 1, 2017 Prescription Drug List Updates for Hemophilia Factor Products and Treatment Cost Driver
November 7, 2016
Based on the expanded number of products containing the same active ingredient available to treat hemophilia, UnitedHealthcare is able to lower overall costs. The recombinant hemophilia factor products approved for the treatment of hemophila A (Factor VIII (8) deficiency) and hemophilia B (Factor IX (9) deficiency) were reviewed and changes were made to UnitedHealthcare’s Prescription Drug List (PDL) for coverage of hemophilia factor products effective Jan. 1, 2017.
- Standard half-life recombinant Factor VIII products
- Kovaltry®, Novoeight®, and NUWIQ®, previously excluded, will now be covered as Tier 2 products. Recombinate, ADVATE, and XYNTHA®/XYNTHA SOLOFUSE® will move from Tier 2 to Tier 3 or 4 (depending on benefit design). Helixate® FS will move from Tier 2 to excluded from coverage.1
- Generally dosed every 2 or 3 days
- Extended half-life, long-acting recombinant Factor VIII products
- Adynovate® will continue to be excluded from coverage
- Eloctate® is covered and coverage remains unchanged
- Generally dosed 2 or 3 times a week
- Standard half-life recombinant Factor IX products
- IXINITY® will continue to be excluded from coverage
- Generally dosed 2 times a week
For additional information on UnitedHealthcare pharmacy benefit strategies for Jan. 1, 2017, please select one of the links below to view the presentation:
Hemophilia Treatment Cost Drivers
Three forces will drive costs for hemophilia treatment going forward:
- Driver 1: Longer Lifespans
Therapies have helped to stabilize hemophilia patients, and as a result, we face a demographic shift with increasing numbers of persons afflicted with the disease now living far longer than they once did, even just a few decades ago.2
- Driver 2: Inhibitors
Some patients develop a resistance to clotting factor infusions. These patients must receive additional therapy to help them overcome this resistance. These are some of the most expensive cases to treat.3
- Driver 3: New Drugs
The market for hemophilia drugs is seeing an influx of new drugs.4 Some with slightly longer periods needed between treatments have already arrived. Other, even longer-lasting clotting factors are also on their way to the market.
- While there is no cure for hemophilia, many people with the disease can lead fairly normal lives by taking a few common sense precautions: While regular exercise can help to build muscle and protect joints, contact sports, such as football or hockey, are not safe for people with hemophilia.5
- Hemophiliacs should avoid certain pain medications that can aggravate bleeding, including aspirin and ibuprofen, and also blood-thinning medications such as heparin, Coumadin®, Plavix® and Effient®.5
Many patients and their families rely on specialized hemophilia treatment centers (HTCs) for help. The BriovaRx® Specialty Pharmacy program devoted to hemophilia makes a special point to connect patients with their nearest HTC. In addition to ongoing consultations with one of our specialty pharmacists, the HTC teams help monitor each patient’s treatment to avoid complications.
What to Do
Conditions like hemophilia offer one of the best illustrations of the principal that all health care is tightly connected. An organization that attempts to manage just the cost of the clotting factor is missing the bigger picture of managing the overall condition and spend. UnitedHealthcare does this with perceptive insights into all dimensions of spending – not just pharmacy.
View the flier provided to find out more about our comprehensive, patient-centered approach that has demonstrated to be cost-effective and successful in helping members manage hemophilia:
1 Helixate FS and Kogenate® FS are the same product made by the same manufacturer, Bayer. They are marketed under different brand names via a licensing agreement which allows CSL Behring to sell Kogenate FS under the Helixate FS brand name in the United States. This licensing agreement will end in 2017 and Helixate FS will exit the U.S. market at that time. Excluding Helixate FS earlier than its market removal will allow for ample time to notify and transition members to Kogenate FS.
2 American Society of Hematology. New challenges in hemophilia: long-term outcomes and complications. ASH Education Book December 8, 2012. Accessed at: http://asheducationbook.hematologylibrary.org/content/2012/1/362.full on 093.17. 2015.
3 CDMI Report. Understanding Hemophilia: A Managed Care Review. Fall 2013. Accessed at: http://www.cdmihealth.com/CDMI_Journal/Fall_2013/files/assets/FALL%202013_FINAL2.pdf on 01.30.2015.
4 Fierce Pharma. Long-acting hemophilia meds portend a pricing fight with older drugs. Mar 10, 2014. Accessed at: http://www.fiercepharma.com/story/long-acting-hemophilia-meds-portend-pricing-fight-older-drugs/2014-03-10 on 01.29.2015.
5 Mayo Clinic. Diseases and Conditions: Hemophilia. Sep. 26, 2014. Accessed at: http://www.mayoclinic.org/diseases-conditions/hemophilia/basics/causes/con-20029824 on 10.17.2014.
January 1, 2017 PDL Updates
The following updates will take effect for the OptumRx direct Prescription Drug Lists (PDLs) on January 1, 2017. Learn more
New Sales Automation Management Tool
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