When we released our Medicaid Pharmacy Trend Report for the first time last year, we received a lot of great feedback from our customers, drug manufacturers and other interested parties. The most common request we received was to identify the drivers of cost in the fast growing area of specialty within the Medicaid pharmacy space.
They asked and we listened! This year’s second edition of the Medicaid Pharmacy Trend Report includes detailed insights into the pharmacy economics that drive trend and the cost of care, allowing for states to get more engaged and focused on the key drivers of pharmacy management, especially when it comes to specialty drugs.
Like commercial plans, states are not immune from the higher costs associated with specialty drugs. While the traditional drug trend was flat over the two-year period, the Medicaid fee-for-service (FFS) space experienced double-digit growth in specialty, which is similar to what we’re seeing with commercial plans. This report highlights opportunities for states to consider a more innovative management approach to high spend, high growth drug classes.
Other key highlights from this year’s Medicaid Pharmacy Trend Report include:
- Even though utilization of specialty products remained constant, the percent of total net spend attributed to specialty drugs increased by almost 5 percent.
- For the second year in a row, states’ efforts to curb the prescription volume of short-acting narcotics and opioids resulted in a 10 percent decline in utilization.
- The top 5 drug classes, which contribute 40 percent of total net spend account for only 14 percent of total claims. Of those five classes, two were specialty classes; HIV/AIDS and Hemophilia.
- Six of the top 10 drugs by net spend were specialty drugs (Harvoni, Advate, Triumeq, Genvoya, Stribild, Orkambi)
Although states are restricted from using some of the tools that commercial plans do to manage specialty spend, there are still opportunities to tackle specific drug classes, such as Hepatitis C, as costly treatment continues to create significant financial burdens on state Medicaid programs.
We’ll talk more about what state Medicaid pharmacy programs are experiencing during our free webinar on September 27, 2017 at 2 p.m. Eastern.