EAGAN, Minn. – Oct. 12, 2023 – Prime Therapeutics LLC (Prime) and Magellan Rx Management LLC (Magellan Rx) released the 13th annual Medical Pharmacy Trend Report^™, featuring a comprehensive view of provider-administered medical benefit drug trends, the largest driver of specialty drug spend. This report offers detailed analysis of medical benefit drug claims, data benchmarks, and current medical benefit drug management strategies.

“As experts in medical pharmacy, we’re dedicated to providing clients with the right data to inform strategic health care planning and forecasting,” said Kristen Reimers, RPh, senior vice president, specialty clinical solutions for Prime/Magellan Rx. “It’s gratifying to bring to market our signature medical trend report in its thirteenth edition. This report delivers premium insights into trends, pipeline forecasts, and management strategies related to medical benefit drug management.”

2022 per member per month (PMPM) trends

Commercial
This year’s report finds a 36% increase in hospital outpatient administration for the commercial line of business (LOB) over the past five years.

• Returning to pre-pandemic levels, Commercial saw a +13.5% year-over-year trend in spend, largely driven by increased utilization across the majority of therapies.
• There was also an increase in the percentage of claims from the outpatient hospital setting, which are typically reimbursed at higher rates than other sites of care.

Government programs
Medicare and Medicaid saw overall utilization continue to decline, while cost trend increased due to use of high-cost therapies.

• Medicaid experienced a negative trend of -1.6% PMPM spend, largely due to less utilization of all medical drugs.
• Although Medicare’s overall utilization was lower year over year, growth in oncology and hematology utilization led to increases in the average cost per claim, which drove the PMPM trend up +4.5%.

 Medical pharmacy trends and forecast: Oncology continues as top trend driver

• The oncology category was a top driver of trend and is forecasted to continue to significantly influence growth in spend.
• For Commercial, the oncology category was up by 19.5%, with five of the 10 top medical benefit drugs by spend in this category.
• While not as dramatic in Medicare, PMPM spend was up 5% year over year, with oncology drugs accounting for six of the 10 top medical benefit drugs.
• Medicaid saw a +3.1% change year over year, with three oncology drugs among the 10 top medical benefit drugs.
• The spend and utilization of Keytruda^® – an immunotherapy used to treat melanoma, lung, and numerous other cancers – remained high and is steadily increasing, climbing 58% in PMPM and 38% in utilizers in Commercial.
• Multiple myeloma therapy was a top spend category in Medicare, increasing 18.6%; this was mainly due to increased utilization of newer therapies, particularly Darzalex Faspro^® and Kyprolis^®.

Where oncology biosimilars come in

Oncology biosimilars are capturing more than 75% of the market across all lines of business. These products are examples of how biosimilars can influence a market basket and lower the cost of lifesaving therapies. Biosimilar development and adoption have reduced oncology spend and will continue to do so as more products come to the market. Embracing biosimilar strategies can play a significant part in easing medical drug costs moving forward.

Payer strategies

Managing medical drug benefit trend and spend remained a top concern for payers in 2022. Gene and cell therapies and oncology were the No. 2 and No. 3 top concerns respectively for payers, likely because 10 new gene and cell therapy products were approved in the last year and the pipeline in oncology continues to brim with innovation.

The annual Medical Pharmacy Trend Report is just one of the many ways Prime/Magellan Rx keep the industry updated on the latest trends for medical benefit drugs and the specialty pipeline. To learn about Magellan Rx’s more than 19 years of experience and commitment to developing innovative clinical programs that address these trends and help payers proactively improve overall cost and quality, read about the company’s total specialty drug management approach and medical pharmacy solutions.