Prime Therapeutics LLC (Prime) today released its 14th annual Medical Pharmacy Trend Report. The report provides a deep analysis of drugs covered on the medical benefit. Prime’s report is the only one of its kind to include survey data showing payers’ top concerns around medical benefit drug management and health plan utilization management strategies cohesively with health plan claims data.

The 2024 edition analyzed 2023 health plan paid claims data that showed the following increased year over year per member per month (PMPM) trend across all lines of business:

• Commercial trend was up 11.2% ($49.08 PMPM in 2023).
• Medicare trend increased by 12.2% ($78.35 PMPM in 2023).
• Medicaid trend grew by 3.9% ($20.24 PMPM in 2023).

Utilization trends were up in commercial and Medicare and remained flat in Medicaid. In the government businesses, cost per claim rose as utilization shifted from lower-cost drugs to higher-cost therapies. For commercial, a decrease in cost per claim helped offset the growth in utilization. Oncology remained the top spend therapy category across all lines of business. Additional drivers of trend included decreased rare disease spend in Medicaid, a shift to higher-cost ophthalmic agents in Medicare and continued decreases in spend due to biosimilar increased uptake.

The report also illustrates 2023 top spend drugs’ impact on trend, citing (pembrolizumab) Keytruda® as the top drug by spend across all lines of business. Additionally, the report provides forecasts for top spend categories such as rare disease, oncology, autoimmune drugs, multiple sclerosis and more.

To gain some expert insight, we caught up with report authors Lisa Polakowski, PharmD, MBA, director, medical benefit drug trend report, and Laura Walters, RPh, director, specialty clinical solutions.

Jenine Anderson: Why does Prime publish this report?
Lisa Polakowski and Laura Walters: Our flagship report is highly anticipated by the medical pharmacy community and is utilized as a referenced resource. Payers leverage it to make informed medical drug management decisions, and it provides actionable data to share with employers and other stakeholders. Pharmaceutical manufacturers rely on the report to understand how their products are being utilized in terms of spend and trend. 

What distinguishes the Medical Pharmacy Trend Report from other industry specialty reports? 
Our payer survey data incorporated with paid claims data sets this report apart. Health plans share candid, real-world feedback that gives us a clear view into their unique challenges with medical benefit drugs. In turn, Prime provides actionable facts to assist stakeholders with a data-driven decision-making process. In fact, the report is frequently cited as a resource during presentations at pharmacy conferences, including Academy of Managed Care Pharmacy (AMCP).

What story does the 2024 Medical Pharmacy Trend Report tell?
This year’s report has six oncology deep dive sections plus a section on oncology biosimilars. 

Biosimilars continue to impact medical pharmacy as utilization shifts to lower-cost biosimilars. Biosimilar market share fluctuated across several oncology categories. In the oncology supportive category, (pegfilgrastim) Neulasta®’s market share decreased for all lines of business, while there was increasing uptake of pegfilgrastim biosimilars. Although Neulasta® is still a top 10 drug by spend for commercial and Medicaid, it no longer is for Medicare, for the first time in 14 years. The decrease in market share was offset by a large increase of biosimilar (pegfilgrastim-jmdb) Fulphila® across all lines of business.

Additionally, ocular injections continue to impact total overall spend and PMPM within commercial and Medicare. While bevacizamab (Avastin®) ophthalmic injections remain standard of care, biosimilar uptake has made some small gains in this category but is expected to grow in the coming years. For Medicare, the ophthalmic category is second only to oncology and makes up 11.6% of overall spend, which illustrates the impact the ophthalmic injections have on trend.

And new this year, we have commentary on vaccines and drugs approved via the 505(b)(2) pathway.

What is Prime doing to help payer clients stay out ahead of/mitigate medical drug costs/trends?
In the report, we provide a three-year forecast for each therapeutic class to help payers anticipate how trends may change in the coming years to plan appropriate clinical strategies. Leveraging client data, we can help them predict new impact and upward/downward trends to plan accordingly for formulary placement, utilization management and cost mitigation strategies. Throughout the year, we discuss pressing topics and trends in the medical pharmacy world in our many clinical publications, at client and industry meetings and one on one with clients. 

Anything else you’d like our followers to know?
This report is made possible because of our dedicated team of clinical and data analysis experts. They are the reason we’re able to provide such a comprehensive report of medical pharmacy trends.

Prime is hosting a webinar from 1–2 p.m. ET on Oct. 24 to discuss in detail the findings of the 2024 Medical Pharmacy Trend Report and its implications for all stakeholders. With its deep insights and forecasting, the 14th annual edition is the industry’s premier comprehensive resource offering detailed analysis of medical benefit drug claims, data benchmarks and current medical benefit drug management strategies.

Submit questions for report authors to mptrends@PrimeTherapeutics.com.

Register for the Oct. 24 webinar.