In the first half of this year, Prime Therapeutics LLC’s total specialty trend for its commercial clients was 15.2%: a 3.7% increase in unit cost and an 11.5% boost in utilization. But, countered by a -5.1% total traditional trend, Prime’s overall drug trend was 0.8% when compared with the same period in 2016, according to its Fall 2017 Mid-Year Update, released Oct. 12.

According to the PBM’s other two mid-year reports, among its Medicaid clients, specialty trend was 1.4%, and overall trend was -1.8%, and Medicare Part D clients had a specialty trend of 3.1%, with an overall trend of -0.1%.

Within the top 10 drug categories among commercial clients, four were specialty: autoimmune, which was in the No. 1 overall spot with a 24.9% trend; oral cancer drugs at No. 4 and a 19.8% trend; multiple sclerosis, No. 5 and a 4.2% trend; and hepatitis C, No. 9 and a -3.7% trend. Among the top 10 drugs, five were specialty products: No. 1 Humira (adalimumab) Pen, No. 2 Harvoni (ledipasvir/sofosbuvir), No. 3 Enbrel (etanercept) SureClick, No. 6 Copaxone (glatiramer acetate) and No. 9 Stelara (ustekinumab). Prime also revealed the drugs on its pipeline watchlist that it’s closely tracking in 2017 (see table below). According to the company, clients that used its NetResults formulary in the first half of 2017 had drug trend an average of eight percentage points lower than clients that did not adopt that approach. Overall, Prime estimates that various management approaches have produced $846 million in savings for its commercial clients this year.

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2017 High-Cost Drug Pipeline

Drug Brand (generic)


Potential Cost Impact*

FDA approved**

Ocrevus™ (ocrelizumab)

Multiple sclerosis

$0.08 – $0.39 PMPM

Dupixent® (dupilumab)

Atopic dermatitis

$0.08 – $2.00 PMPM

Radicava™ (edaravone)


$0.08 – $0.39 PMPM

Ingrezza™ (valbenazine)

Tardive dyskinesia

<$0.08 – $0.39 PMPM

Translarna™ (ataluren)

Duchenne muscular dystrophy

$0.08 – $0.39 PMPM

Emflaza™ (deflazacort)

Duchenne muscular dystrophy

$0.08 – $0.39 PMPM

Zejula™ (niraparib)

Ovarian cancer

$0.08 – $0.39 PMPM

Kymriah™ (tisagenlecleucel)
[genetically modified CAR-T cells]


$0.08 – $2.00 PMPM

axicabtagene ciloleucel (KTE-C19)
[genetically modified CAR-T cells]


$0.08 – $2.00 PMPM

Luxturna™ (voretigene neparvovec)
[gene therapy]

Inherited retinal disease

<$0.08 – $0.39 PMPM

RoxyBond™ (oxycodone tablets)
[abuse deterrent formulation for immediate release opioid]

Severe pain

$0.60 – $3.60 PMPM

*Includes impact on pharmacy and medical benefit

**As of 9/22/2017

Note: All brand names are the property of their respective owner.

PMPM = per member per month

SOURCE: Prime Therapeutics LLC, Fall 2017 Mid-Year Update, released October 2017. Download the reports at