New Partnership Delivers Precision Medicine to Pharmacy Benefits Managers

Blog 07 via RxSense

Specialty drug spending contributes the largest share to rising healthcare costs. To make matters worse, in the case of rheumatoid arthritis, most patients will, over time, become refractory to these specialty biologics. In some cases, this may happen because the patients develop antibodies to, for example, tumor necrosis factor inhibitors (TNFi), but in other cases it may be because the patients’ molecular profile changes. Either way, the result is that costly medicines are provided to patients who experience no benefit.

Pharmacy benefits managers (PBMs) manage prescription drug benefits on behalf of health insurers, large employers, Medicare Part D drug plans, and other payers. As such, they are uniquely positioned to access a patient’s formulary and support physicians in prescribing the most cost-effective medications on the formulary. They are also well-positioned to base formulary decisions and price negotiations on a drug’s health benefits and its effect on the total cost of patient care. PBMs thus have a powerful role to play in managing rising healthcare costs and need tools that will allow them to rein in costs while protecting patients’ needs.

Scipher Medicine has thus partnered with RxSense, the healthcare technology company delivering industry-leading solutions for pharmacy benefits and prescription savings, to bring precision medicine to PBM decision-making. RxSense’s transformative RxAgile enterprise solutions bring transparency, flexibility and efficiency to pharmacy benefit administration, serving pharmacy benefit managers, regional health plans, health systems, third party administrators, new healthcare and pharmacy entrants and healthcare technology companies. With this partnership, RxSense will offer its clients convenient access to Scipher’s PrismRA® molecular signature test.  PrismRA uses a routine blood draw to analyze an individual’s molecular signature and accurately predict which patients will have an inadequate response to TNFi. It is the first in a series of blood-based molecular signature tests that will allow providers to make evidence-based therapy decisions that improve treatment outcomes.

“Often RA patients waste valuable time trying multiple therapies before the correct medication is prescribed,” said Ramzi Yacoub, Chief Pharmacy Officer at RxSense. “Through our new partnership with Scipher, we’re providing pharmacy benefit managers access to another powerful tool that brings transparency and efficiency in determining the best course of action for treatment.”

PrismRA leverages proprietary data to detect inadequate responders to TNFi therapy in moderate or high disease rheumatoid arthritis. PrismRA can be used to test response to TNFi even before the patient has initiated therapy. Patients can also take the test three or six months into therapy to obtain insight into whether TNFi is likely to be an effective therapy for them. While such precision medicine is common in oncology, its use in rheumatology is novel and PrismRA is the first predictive test in rheumatology.

This approach to precision medicine not only saves money, but it also helps patients. This is because achieving remission with a first-line treatment may improve the ability of patients to maintain their quality of life and avoid disease progression. The partnership between Scipher Medicine and RxSense will thus also pave the way for educating rheumatologists and the community about how best to use precision medicine to save money and help patients. “We are proud to be partnering with an innovations-driven company like RxSense to make PrismRA available to their clients,” said Alif Saleh, Scipher Medicine CEO. “In the absence of precision medicine for RA, our breakthrough technology empowers pharmacy benefit managers to solve some of healthcare’s biggest drug problems – excess waste and improve patient outcomes.”