Specialty drug trend forecasted to drop for employer groups, clinical experts say

Specialty drug trends remain high as new high-cost therapies enter the market, existing medications receive new indications and drug manufacturers invest in innovative treatments for rare conditions.

However, clinical experts at Prime Therapeutics/Magellan Rx Management (Prime/Magellan Rx) predict those costs decreasing over the next three years, primarily due to a declining autoimmune – anti-inflammatory trend. “Overall net-cost trend is forecasted to decrease over the next three years due to a slowdown in the growth of specialty spend because of the introductions of biosimilars,” explained David Lassen, chief clinical officer at Prime/Magellan Rx.

In 2023, the specialty drug trend was 14%, according to Prime/Magellan Rx data, driven by increased utilization from drugs such as Dupixent^® (dupilumab), Rinvoq^® (upadacitinib), Skyrizi^® (risankizumab‐rzaa) and Xolair^® (omalizumab). Three-year projections are anticipated to be considerably lower, thanks to the continued development and approval of biosimilars for Humira^® (adalimumab) and the future entry of Stelara^® (ustekinumab) biosimilars in 2025.

“Several key first-in-class pharmacy pipeline and recently approved agents across metabolic, cardiovascular, autoimmune, hematology and mental health therapeutic categories are forecasted drivers of trend over the next three years,” added Maryam Tabatabai, PharmD, vice president of clinical information at Prime/Magellan Rx.

As employers determine how to best cover the rising costs of prescription medications for their employees, Prime/Magellan Rx’s newly released Employer Market Insights Report™ aims to empower business leaders to make the best decisions for their organizations and the people they serve.

“Our innovative and forward-looking analytics, built on robust statistical, quantitative and predictive principles, provide meaningful insights to support decision makers regarding pharmaceutical trend and spend and impact of key marketplace events,” said Karim Prasla, PharmD, MS, BCPS, vice president of clinical outcomes, analytics and research.

Prime/Magellan Rx is committed to partnering with employers to help drive down costs, optimize drug access and improve medication adherence by ensuring employees are using the most cost-effective medications. This is made possible by flexible solutions designed to improve care, stay ahead of trend and reduce spend.

Learn more about how Prime/Magellan Rx is reimagining pharmacy management and enhancing experiences across health care at primetherapeutics.com.

Methodology and Disclaimer: All forecasts are based on Prime/Magellan Rx’s methodology to project trend impact for years 2024, 2025 and 2026. Forecasting results are based on Prime/Magellan Rx aggregate data to provide directional results for informational purposes only and may not reflect actual results for individual plan sponsors. Prime/Magellan Rx trends may not reflect comparable trends for the Prime employer business.