Ninth annual report features a comprehensive
view of medical pharmacy trends in claims data, including all major
lines of business
Magellan Rx Management, the pharmacy benefit management (PBM)
division of Magellan Health, Inc. (NASDAQ: MGLN) released its ninth
annual Medical Pharmacy Trend ReportTM. The benchmark report is the
industry’s premier detailed resource that offers data for analyzing
medical benefit drug claims as well as current medical benefit drug
management strategies.
Trends Highlight the Need for More Effective Management
Strategies
Commercial per-member-per-month (PMPM) medical drug spend
increased 18 percent to $29.97, above the 14 percent average annual
trend over the last five years. Similarly, Medicare PMPM saw its
largest increase of 12 percent to $52.19, far exceeding the average
annual trend of five percent, due to increases in PMPM spend and
utilization of immuno-oncology agents and other new entrants to the
market.
“The data shows that the trend over the last five years for
Medical Pharmacy drugs was 68 percent, representing the largest
growth over the last nine years, reinforcing the need for effective
management strategies in medications billed through the medical
benefit,” said Kristen Reimers, RPh, senior vice president,
specialty clinical solutions. “Offering a global view of today’s
most significant medical pharmacy trends, the report provides
valuable insights that can help identify effective strategies and
inform smarter decisions for controlling rising spend and managing
the medical pharmacy benefit.”
Site of service continues to be a concern, with drugs
administered in the hospital outpatient setting continuing to cost
2-3 times more than physician offices and home infusion sites of
service. Sixty-eight percent of payers are now using a site of
service program.
Forecasting Significant Medical Benefit Categories
The report illustrates that over the last 12 months there were
significant changes to many provider-administered therapeutic
categories covered on the medical benefit. Novel oncology therapies
and immunotherapy treatments continued to drive the highest spend.
Antihemophilic factor is the category with the highest annual trend
increase at 62 percent in Commercial and 185 percent in Medicare.
Other categories such as enzyme replacement drugs, autoimmune
agents for gastrointestinal (GI) disorders, and new agents in the
asthma category also contributed to the $4 PMPM increase in medical
benefit spend.
According to the report, oncology had the highest PMPM spend
across all lines of business (LOB), with Rituxan, Herceptin and
Avastin remaining in the top five drugs for Commercial plans along
with Opdivo in the top 10. By 2022, chimeric antigen receptor
T-cell therapies (CAR-T) for oncology immunotherapy treatment are
projected to have an increase in PMPM spend of 581 percent.
Programmed-cell death (PD)-1 inhibitor Keytruda (pembrolizumab)
had an impactful increase in utilization with at least a 200
percent increase in PMPM spend in each LOB, vaulting Keytruda into
the top 15 drugs. Opdivo (nivolumab), another PD-1, lost market
share to Keytruda but still accounted for 56 percent of commercial
oncology checkpoint inhibitors.
First Look at Medicaid Medical Pharmacy Analysis
Looking at Medicaid medical pharmacy spending for the first
time, the data revealed that PMPM allowed amounts are lower with an
average of $8.29, vs. $29.97 in commercial and $52.19 in Medicare,
and average annual trend consistent with Medicare at five percent.
The annual cost per patient in Medicaid is higher than Medicare,
indicating that proportional to their respective populations,
Medicaid may have higher incidences of rare, higher-cost disease
states.
Notably, 14 percent of Medicaid patients and 21 percent of
Medicare patients are driving nearly all medical pharmacy spend; 91
percent and 95 percent, respectively.
Review of Biosimilar Reimbursement Strategies
In a large swing from previous years, more than half of payers
(51 percent) required members to step through a biosimilar before
utilizing its reference product; of those payers who do not have
one in place, 41 percent were not planning to implement a step at
all. Looking ahead, 64 percent of payers indicated that the pricing
of biosimilars was most impactful on their reimbursement decisions
with the anticipation that three of the top spend oncology agents
could have biosimilars on the market in 2019.
To learn more about the latest medical pharmacy trends and key
management strategies, register here for our webinar on Thursday,
March 14 at 1 p.m. Eastern.
Magellan Rx Management is a full-service, next-generation
pharmacy benefit manager (PBM) that helps our customers and members
solve complex pharmacy challenges by connecting them to the people,
technology, and information they need to make smarter healthcare
decisions. As experts in managing specialty spend both on the
prescription and medical benefit, we are energized by discovering
new and better ways to deliver solutions in today’s complex and
rapidly-evolving healthcare environment, leading people to live
healthier, more vibrant lives. Magellan Rx Management is a division
of Magellan Health, Inc.
About Magellan Health: Magellan Health, Inc., a Fortune
500 company, is a leader in managing the fastest growing, most
complex areas of health, including special populations, complete
pharmacy benefits and other specialty areas of healthcare. Magellan
supports innovative ways of accessing better health through
technology, while remaining focused on the critical personal
relationships that are necessary to achieve a healthy, vibrant
life. Magellan's customers include health plans and other managed
care organizations, employers, labor unions, various military and
governmental agencies and third-party administrators. For more
information, visit MagellanHealth.com.
(MGLN-GEN)
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version on businesswire.com: https://www.businesswire.com/news/home/20190219005220/en/
Media Contact:Lilly Ackley, ackleyl@magellanhealth.com,
(860) 507-1923
Investor Contact:Joe Bogdan, jbogdan@magellanhealth.com,
(860) 507-1910
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