“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 are also expected to continue to rise, so the need to prioritize strategies specific to specialty and medical pharmacy drugs is essential.”1
The medical benefit drug pipeline is robust, with new therapies and novel agents changing the landscape as they enter the marketplace. Medical pharmacy spend remains a major driver of rising specialty drug trend but goes largely unmanaged and is often overlooked in pharmacy trend statistics. So, how can payers get more information to understand these dynamics and prepare for what’s next?
For 10 years, Magellan Rx has unlocked medical pharmacy trends and continues to deliver the industry’s only detailed report that analyzes medical benefit drug claims for trends, data benchmarking, forecasting for important categories, as well as current medical benefit drug management approaches.[Learn more about Magellan Rx’s approach to 15+ years of medical pharmacy management.]
Top 10 Takeaways
What you need to know from the tenth edition of the Medical Pharmacy Trend Report:2
- Across commercial, Medicare, and Medicaid lines of business (LOB), more than 96% of total medical benefit drug spend on the medical benefit is driven by a smaller proportion of members who are taking specialty medications. Overall, less than 12% of members had a medical drug claim.
- Commercial per-member-per-month (PMPM) spend increased 10%, but it was the lowest percentage increase across all ten editions.
- Across all LOB, there were more than 50 categories of medical benefit drugs and, of those, the top 10 categories accounted for more than 70% of PMPM.
- For the 10th year in a row, the top five commercial drugs were Remicade, Neulasta, Rituxan, Herceptin, and Avastin—all of which now have marketed biosimilars.
- Oncology immunotherapies Keytruda and Opdivo are now in the top 10 drugs by spend for commercial and the top five for Medicare and Medicaid.
- Ophthalmic injections are again the second-highest spend category for Medicare at 13% of PMPM, or $7.89; Eylea saw a 14% increase and is now No. 1 by PMPM spend.
- Billion-dollar drugs are expected to increase by 15%, 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% over the next five years; by 2023, the Medicare oncology pipeline is projected to be worth $10.72 PMPM.
- In the 2019 survey, 44% of payers were specifically concerned with oncology spend—and it remains one of the highest spend categories on the medical benefit, accounting for:
- 35% of commercial PMPM, or $11.42
- 46% of Medicare PMPM, or $28.10
- In 2010, biosimilars were still five years away and there were only nine approvals for medical injectable drugs; in 2019 alone, there were triple that number of approvals and seven of them were biosimilars.
- Magellan Rx Management. “Magellan Rx Management Medical Pharmacy Trend Report Delivers Industry Insights and Forecasting in Notable 10th Edition.” Magellan Rx Management Press Release, April 8, 2020. Accessed 21 April 2020.
- 2019 Magellan Rx Management Medical Pharmacy Trend Report™, © 2020.