Regional differences might exist in the cost of injectables

June 1, 2005

While the overall cost of injectables is relatively consistent from health plan to health plan, regional differences exist in the total cost of individual therapy classes as a result of PMPM utilization, necessitating payers to develop injectable management programs that are customized for their geographical service area. Examples of these regional differences include the higher incidence of multiple sclerosis in northern states, higher prevalence of older Americans in states such as Florida and Arizona (and the associated higher oncology costs), and infertility costs in states where coverage is state-mandated.

While the overall cost of injectables is relatively consistent from health plan to health plan, regional differences exist in the total cost of individual therapy classes as a result of PMPM utilization, necessitating payers to develop injectable management programs that are customized for their geographical service area. Examples of these regional differences include the higher incidence of multiple sclerosis in northern states, higher prevalence of older Americans in states such as Florida and Arizona (and the associated higher oncology costs), and infertility costs in states where coverage is state-mandated. Let's review the management of infertility drug costs, since it serves as an example of how therapy cost may vary from plan to plan.

TREATMENT STEPS Three basic steps exist in treating infertility: ovulation induction (OI), intrauterine insemination (IUI), and in-vitro fertilization (IVF). The table outlines the associated medications. OI should use generic oral medicines to stimulate ovulation, costing less than $50 per cycle. With approximately $1,000 in non-drug costs per cycle and three cycles total, costs average $3,500. IUI uses FSH and hCG together, which cost about $1,000 for the injectables and $1,000 in non-drug therapy per cycle. Average total treatment is approximately $6,000. IVF is the most costly of these treatments, and is performed after OI and IUI have failed. IVF uses a combination of FSH, hMG, hCG and GNRH or LHRH agonists. IVF costs about $4,500 in drug and $6,000 in non-drug treatment per cycle for one to six cycles, with a total treatment cost averaging about $36,000.

Kjel A. Johnson, PharmD, BCPS, FCCP, is vice president of strategic operations for ICORE Healthcare in Orlando.