Eighth Annual Navitus Drug Trend Report Reveals How Plan Sponsors Save on Prescription Drugs Amid Rising Costs and Inflation
July 15 2024 - 6:00AM
Business Wire
29% of Navitus’ commercial clients saw a
decrease in their prescription drug costs between 2022 and 2023
Navitus, an innovative pharmacy benefit manager (PBM), released
its 2023 Drug Trend Report today. The eighth annual report shows a
year-over-year trend of 6.8% within the commercial book of
business. 29% of Navitus commercial clients paid less for
prescription drugs in 2023 than they did the previous year - even
with inflation and the growing use of expensive new medications
like GLP-1s.
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In 2023, the Navitus drug trend growth
was influenced by higher-cost brand name drugs but mitigated by
generic specialty medications. (Graphic: Business Wire)
The Navitus Drug Trend Report shows that the organization’s
ability to out-perform industry trends is the result of a strategic
approach that focuses on delivering the lowest net cost to clients,
100% transparency on drug costs and a people-first mission.
Across market segments, clients saw a negative trend within
their first year with Navitus. In 2023, new clients realized an
average 11% reduction in costs compared to the previous year with a
different PBM. Cost trend is the calculated year-over-year change
in costs driven by how many people are using a drug and the unit
cost of a drug.
Unlike traditional PBMs that profit from a portion of the
rebates they receive from pharmaceutical manufacturers, Navitus
passes all discounts, rebates and fees directly to customers with
auditable reporting. The traditional big three PBMs and drug
manufacturers obscure drug prices by steering patients to high-cost
drugs while keeping rebates at the expense of plan sponsors and
consumers.
“Five years ago, we left our previous PBM, one of the big three
providers, and turned to Navitus to provide the transparency,
insights and flexibility we need to help deliver lower-cost,
exceptional service to our members,” said Brian Naiser, Financial
Manager Health & Benefits Services, Texas Association of
Counties. “In the first year alone, we reduced pharmacy costs by
28% and continue to outperform industry trends, to date saving more
than $160 million with Navitus.”
Several industry-wide trends impacted prescription drug
spending, including rising drug costs and utilization in the
non-specialty category, clinical advancements and the introduction
of higher-cost specialty drugs and the availability of lower cost
alternatives. By driving to the lowest drug acquisition price
including rebates, Navitus customers realized savings from
clinically appropriate, lower-cost options like generics or
biosimilars when available.
“The rising drug costs and growing demand for GLP-1s were
partially offset by lower-cost alternatives including specialty
biosimilars and generics,” said Brent Eberle, RPh, Chief Pharmacy
Officer at Navitus. ”Plans are depending on Navitus to provide
transparency to drug costs to help them make informed decisions and
weed out needless expenses so they can pass along savings to their
employees and members.”
Significant trend drivers include:
- Growth of GLP-1s (Glucagon-Like Peptide-1)—In 2023
several factors contributed to high trend within non-specialty.
However, no singular factor had more impact on trend than GLP-1s
did. While highly effective, GLP-1s including Ozempic (semaglutide)
and Mounjaro (tirzepatide) are costly. Diabetic GLP-1 medications
were the biggest contributor to trend growth in 2023. A Navitus
diagnosis check program helped combat off-label use of GLP-1s,
mitigating 30% of prescriptions being filled without an appropriate
diagnosis.*
- Impact of Biosimilars—The launch of biosimilar products
for Humira (adalimumab) reduced drug spend for clients with
utilizing members. These injectable biologic drugs have proven very
helpful for inflammatory diseases like arthritis or Crohn’s
Disease, but biosimilars are just now reaching wide adoption. These
are expected to significantly lower costs in 2024, as utilization
shifts drive the industry towards more competitive pricing.
- Attention-Deficit/Hyperactivity Disorder (ADHD)—While a
generic version of Vyvanse (lisdexamfetamine) was released for the
treatment of ADHD, drug shortages reduced competition and limited
the opportunity for price reductions.
- Opportunities with Generics and Specialty
Medications—Generic launches for multiple sclerosis treatment
and strong generic utilization rates across oncology contributed to
savings in the specialty category.
“We continue to strengthen our transformative pass-through
approach to provide our clients with a lowest-net-cost formulary
and supportive clinical care model,” said Eberle. “With this system
in place, our utilization, formulary and network management
continue to perform at a higher level, resulting in improved health
and even more savings.”
Access the full Navitus 2023 Drug Trend Report here.
Methodology: The Navitus drug trend is calculated by comparing
the net total cost per-member per-month (PMPM) for 2023 to that of
2022. Net cost PMPM represents full-year (Q1-Q4) data for total
member copays and plan paid amounts minus manufacturer rebates and
fees. This value is divided by the total number of members and by
12 months of the year.
*Due to varying coverage decisions by clients, GLP-1s for weight
loss were not included in the Drug Trend Report, yet they still
warrant thoughtful consideration and conversation in the overall
picture of trend and future decisions.
About Navitus Navitus is a pharmacy benefit manager (PBM)
that uniquely brings clarity to drug pricing and takes costs out of
the drug supply chain. Unlike traditional PBMs that generate profit
by retaining an undisclosed portion of rebates from pharmaceutical
companies, Navitus passes along the complete savings to plan
sponsors and health plans, enabling them to make medications more
affordable for their members. Navitus is part of Navitus Health
Solutions, LLC, a pioneering pharmacy solutions company established
more than 20 years ago. The organization delivers a range of
solutions through portfolio brands and partners including Navitus,
EpiphanyRx, Lumicera, Archimedes, and CivicaScript. Owned by SSM
Health and Costco, Navitus Health Solutions serves over 14 million
lives across 800 clients including employers, unions, government
plans, payors and health systems. For more information, please
visit www.navitus.com.
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Sarah Broome navitus@aircoverpr.com