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IG-Study-Photo-with-spacers.jpg A real-world study of immunoglobulin (IG) reveals multiple cost-saving opportunities 




An exploration into use of immunoglobulins (IG), costly blood-derived products accounting for more than $500m in annual spending in the Elevance Health affiliated health plan membership, reveals substantial IG use for off-label indications and in the most expensive site of care. According to the results of a Carelon Research (formerly HealthCore) study, improved evaluation of prescribed uses and the addition of site-of-care programs may result in an estimated $34.1m in annual savings.

Enterprise Analytics Core domain(s): Immunology, oncology, costs of care, CarelonRx, policy guidance

Summary

Background
Immunoglobulins (IG) are costly blood-derived products accounting for more than $500m in annual spending in the Elevance Health affiliated health plan membership.

Methods
Carelon Research examined IG utilization using claims data to evaluate appropriateness of use, the extent of site-of-care optimization and non-preferred IG use.

Results

  • The findings revealed significant off-label use of IGs (30%), including 22% for indications that were neither approved by FDA nor covered by Elevance Health affiliated health plan, but were accepted by other health plans; and 8% for indications that were neither approved by FDA nor covered by any health plan.
  • Additionally, 25% of the IG use was observed in the most expensive site of administration of hospital outpatient (HOPD) and non-preferred IG use accounted for majority of the total IG use.


Key takeaways
Examining the IG uses from various dimensions presents several opportunities to CarelonRx and Elevance Health affiliated health plan:

  • Reducing off-label IG use represented an estimated $27.8m annual savings opportunity
  • Shifting IG utilization from HOPD to a less expensive site of care could drive a further estimated $6.3m in annual savings
  • The study also identified opportunities to increase the share of preferred IG products used by Elevance Health affiliated health plan members

Carelon Research project team: Shivani Pandya, Jason Tan, Zhengzheng Jiang, Bal Nepal, Megan Reidy 



For more information on a specific study or to connect with the Actionable Insights Committee, contact us at [email protected].

This study was conducted by Carelon Research (formerly HealthCore), a subsidiary of Elevance Health, and funded by the Elevance Health-CarelonRx research collaboration. Dissemination and sharing of the Newsletter is limited to Elevance Health and its subsidiaries and included findings and implications are for Elevance Health and its affiliates’ internal use only.



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Highlighted Studies

A real-world study of immunoglobulin (IG) reveals multiple cost-saving opportunities 

Hub Domain(s): Immunology, oncology, costs of care, IngenioRx, policy guidance
Summary: 

  • Background: Immunoglobulins (IG) are costly blood-derived products accounting for more than $500m in annual spending in the Anthem membership
  • Methods: HealthCore examined IG utilization using claims data to evaluate appropriateness of use, the extent of site-of-care optimization and non-preferred IG use.
  • Results: The findings revealed significant off-label use of IGs (30%), including 22% for indications that were neither approved by FDA nor covered by Anthem, but were accepted by other health plans; and 8% for indications that were neither approved by FDA nor covered by any health plan
    • Additionally, 25% of the IG use was observed in the most expensive site of administration of hospital outpatient (HOPD) and non-preferred IG use accounted for 71% of the total IG use
  • Key Takeaways: Examining the IG uses from various dimensions presents several opportunities to IngenioRx and Anthem:
    • Reducing off-label IG use represented an estimated $27.8m annual savings opportunity
    • Shifting IG utilization from HOPD to a less expensive site of care could drive a further estimated $6.3m in annual savings
    • The study also identified opportunities to increase the share of preferred IG products used by our patients.


Major depressive disorder (MDD) patients highly impacted by COVID-19 face daunting challenges

Hub Domain(s): COVID, member experience
Summary: 

  • Background: Disruption to daily life and lockdown measures that were imposed in an attempt to contain the spread of COVID-19 presented new hurdles for at-risk populations, such as patients with major depressive disorder (MDD)
  • Methods: Conducted a 2020 internet survey to understand reasons for antidepressant continuation, switching and discontinuation in patients with MDD; COVID-19 pandemic questions were developed and added to survey.
    • COVID-19 Pandemic Impact (CPI) score was calculated and, based on their CPI scores, patients were categorized as experiencing low (LPI), medium (MPI) or high pandemic impact (HPI).
  • Results: Compared with LPI and MPI patients, HPI patients reported:
    • Significantly more problems accessing healthcare; few reported not having health insurance benefits due to loss of/reduced health insurance coverage (Figure 1).
    • More challenges obtaining depression prescription medications in terms of:
      • Filling new/current prescription(s)
      • Receiving samples from healthcare providers
      • Paying for prescription(s) due to loss of/reduced health insurance coverage and/or pharmacy benefits
    • Since start of COVID-19 pandemic engaged in significantly more:
      • Alcohol, drug, and tobacco use
      • Unhealthy mindless eating
      • Sedentary behavior
  • Key Takeaways: Our findings are consistent with literature showing that traumatic events, e.g. pandemics, can negatively impact health behaviors.
    • More research is needed to explore the COVID-19 impact in other patient populations.
    • Education opportunities exist for health plans to increase awareness among providers and patients of possible short and long-term COVID-19 effects on health behaviors.

Figure 1: Impact of COVID-19 pandemic on accessing healthcare/mental healthcare

  • Publications: Poster presented at the Virtual American Society of Clinical Psychopharmacology (ASCP) Annual Meeting, June 1-4, 2021

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