Four Keys to 2021 Medicaid Pharmacy Trends

As the Medicaid pharmacy landscape continues to evolve, so do the trends! The sixth annual Magellan Rx Management Medicaid Pharmacy Trend Report™ provides Medicaid fee-for-service (FFS) payers with key insights, examining pipeline drugs and therapies, drug class trends, and forecasting of future spending. Additionally, the report’s takeaways prompt meaningful discussion and inspire the identification of strategic opportunities to manage Medicaid pharmacy programs in the years ahead.

2020 was a challenging year for everyone, but it was an especially dynamic year in Medicaid. Healthcare saw significant advances in technology and approach which benefitted all programs including state Medicaid. States continued to explore unique payment models while rethinking population outreach and growth. New specialty drugs impacted the hepatitis C and cystic fibrosis market, driving costs up in those particular classes and sparking the need for innovative management strategies. Here are 4 key takeaways from this year’s report:

  1. Specialty costs have outpaced traditional.

Specialty net cost in Medicaid FFS has crossed the threshold and accounted for 51.4% of spend while continuing to make up a small 1.3% of utilization. 2020 could signal a shift in the speed and process for FDA approvals, opening the door for an influx of new specialty drugs in addition to the already robust pipeline.

  1. Trends continue to rise.

As a robust pipeline continues to spur innovation in the drug landscape, the introduction of new drugs to the market is causing a rise in spending.  New treatments are leading to increases in trends for both traditional and specialty drugs, positively impacting traditional trends for the first time in six years of this report.

  1. Even with a robust pipeline, top drug classes in Medicaid are steady.

HIV/AIDS and antipsychotics continue to be the highest spend classes for this market. Leading the pack with the highest net dollar impact and highest net spend is HIV/AIDS. Biktarvy, after three years on the market, is the number one net spend product in Medicaid overall and has a quarter of the market share. In traditional, antipsychotic quetiapine (Seroquel) garnered the highest market share in the class at 23.8%.

  1. Forecasted drug spend and future innovations make it possible to prep for and manage future costs.

MRx Predict, our proprietary advanced analytics platform, shows that the overall gross trend in Medicaid is expected to increase steadily until 2023, where it drops 1.5%. The net trend shows an increase until 2023, followed by a gradual tapering to 0.6%. Connect with us today to discuss value-based models for managing these trends.

For more on Medicaid trends, dive into our 2021 Medicaid Trend Report.

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