Magellan Rx Management Medical Pharmacy Trend Report Delivers Industry Insights and Forecasting in Notable 10th Edition
April 08 2020 - 6:30AM
Business Wire
Magellan Rx Management, a division of Magellan Health, Inc.
(NASDAQ: MGLN), released its tenth annual Medical Pharmacy Trend
Report™, featuring a comprehensive view of medical benefit drug
trends—one of the largest drivers of total specialty drug spend.
For 10 years, Magellan Rx has produced the industry’s only detailed
trend report that analyzes medical benefit drug claims for trends,
data benchmarking, forecasting for significant categories, as well
as current medical benefit drug management approaches.
Dramatic Changes Over 10 Years of Reporting
- Commercial per-member-per-month (PMPM) medical drug spend has
almost doubled (90 percent) from $17.28 to $32.83 from
2009-2018.
- Medicare PMPM has increased by more than one-third (35
percent), from $45.59 to $61.47.
- Remicade, Rituxan, Herceptin, Neulasta, and Avastin continue to
rank as the top five drugs in commercial PMPM medical drug spend
over the same 10-year period.
- Remicade has remained the top drug in commercial PMPM and the
medical benefit spend has more than doubled from $0.94 in 2009 to
$2.95 in 2018, a 214 percent increase.
Current Trends to Watch
- Medical pharmacy trends continued to climb with commercial PMPM
increasing 10 percent year over year. In addition, from 2017 to
2018, there was an eight percent and seven percent increase in PMPM
for Medicare and Medicaid, respectively.
- Oncology spend remains one of the highest spend categories on
the medical benefit, accounting for 35 percent of commercial PMPM,
or $11.42, and 46 percent of Medicare PMPM, or $28.10. In the 2019
survey, 44 percent of payers were specifically concerned with
oncology spend.
- Billion-dollar drugs are expected to increase by 15 percent,
from 33 drugs in 2018 to 38 in 2024, due to the introduction of
novel treatments such as gene therapy. In the oncology category
alone, spend is forecasted to grow by 69 percent over the next five
years. By 2023, the Medicare oncology pipeline is projected to be
worth $10.72 PMPM.
“The FDA approved 31 medical benefit drugs in 2019 and the
introduction of gene therapies and other novel agents will
continue,” said Kristen Reimers, RPh, senior vice president,
specialty clinical solutions, Magellan Rx Management. “The trends
in medical drug spend will also continue to rise, so the need to
prioritize strategies specific to specialty and medical pharmacy
drugs is essential.”
Additionally, six new medical pharmacy drugs were approved in
2019 for rare diseases, including treatments for spinal muscular
atrophy, anemia due to beta thalassemia, and sickle-cell
disease.
The Future of Biosimilars and the Medical Benefit
Over the past two years, there has been a significant increase
in approved biosimilar products. As of early March 2020, the FDA
had approved 26 biosimilar products across three different
therapeutic categories of which 15 have been launched to date. Of
these approvals, 13 are oncology or oncology support agents.
Biosimilars are making an impact in the oncology support
category and are expected to be impactful in the oncology category,
as biosimilars are now available for three of the top oncology
drugs: Herceptin, Rituxan and Avastin. In addition, payers are
increasingly using biosimilars to more actively manage the medical
benefit, with 63 percent of payers preferring the biosimilar over
the reference product. As biosimilars enter the landscape in a
meaningful way, payers have experienced between 8 to 23 percent in
self-reported savings.
While biosimilars offer the opportunity for significant cost
savings, the emergence of gene therapies is the new cost concern
for payers managing the medical benefit. Based on the survey,
payers continue to use innovative strategies to better manage
medical pharmacy trend, such as site of service, weight-based
dosing, vial rounding, and dose optimization.
“Working directly with payers and providers, Magellan Rx
continues to deliver quality clinical solutions and medical
pharmacy management strategies that can have a meaningful impact on
improving patient outcomes, maintaining a high quality of care for
members and lowering patient out-of-pocket costs,” said Reimers.
“Our medical pharmacy programs have already saved customers over $2
billion dollars, and we continue to leverage our knowledge and
expertise to create innovative solutions, like the drug wastage
reduction program, that are on the leading edge of total specialty
drug management.”
To learn more about the latest medical pharmacy trends and key
management strategies, watch Medical Pharmacy Trend Report webcast
here.
About Magellan Rx Management: Magellan Rx Management, a
division of Magellan Health, Inc., is shaping the future of
pharmacy. As a next-generation pharmacy organization, we unlock the
possibilities by delivering meaningful solutions to the people we
serve. As pioneers in specialty drug management, industry leaders
in Medicaid pharmacy programs and disruptors in pharmacy benefit
management, we partner with our customers and members to deliver a
best-in-class healthcare experience.
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/20200408005191/en/
Media Contact: Kristen Durocher,
kdurocher@magellanhealth.com, (860) 507-1983 Investor
Contact: Joe Bogdan, jbogdan@magellanhealth.com, (860)
507-1910
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