^{Lisa Polakowski is the director of the Medical Pharmacy Trend Report at Prime Therapeutics.}

Imagine being told you have Crohn’s disease or ulcerative colitis (UC). For many, the diagnosis comes after months or sometimes years of unexplained pain, fatigue or other disruptive symptoms. Relief often starts with an infusion chair: induction therapy delivered intravenously (IV) in a clinic or hospital setting. But that’s just the beginning. These conditions are lifelong, and maintenance treatment often involves subcutaneous (SC) biologics that patients self-administer at home. For health plans, this journey isn’t just clinical; it’s financial. Each decision — IV versus. SC, brand versus biosimilar, site of care — carries cost implications. That’s why trend, spend and forecasting data aren’t optional; they’re essential tools for anticipating risk, shaping benefit strategy and helping ensure members get the right therapy at the right time without breaking the budget. 

2024 data deep dive 

• Across Prime Therapeutics (Prime)’s book of business, biologic drugs for autoimmune disorders (BDAIDs) treating Crohn’s/UC remained a top driver, ranked No. 2 by commercial spend at $4.36 per member per month (PMPM), up 1.7% compared to 2023. Entyvio IV was the top-spend agent in this category, with trend flattening as lower utilization was offset by higher cost per utilizer; meanwhile, Skyrizi IV rose from $0.18 to $0.37 PMPM on increased use. 
• In Medicare, Crohn’s/UC ranked No. 6 at $1.53 PMPM, a 25.7% increase year over year. Entyvio IV drove much of that change, with 12.7% more utilizers contributing to a 28.1% PMPM rise suggestive of slower adoption of self-administered options among older members. 
• In Medicaid, Crohn’s/UC spend declined 19.1% to $0.66 PMPM, closely tracking a 19.1% drop in Entyvio IV PMPM. Decreased Remicade spend reflected lower use, while Inflectra biosimilar utilizers increased approximately 30%, with its lower cost per claim helping pull the category down overall. 
• Market dynamics reinforced the story: ongoing infliximab biosimilar uptake; U.S. Food and Drug Administration (FDA) approval of subcutaneous Entyvio (Sept 2023) enabling a channel shift; Skyrizi IV’s UC label expansion (June 2024); the IL-23 agent Omvoh (October 2023) entering the class; and Stelara biosimilars approved in 2024 with launches beginning in 2025, each creating new levers for plans. 

Why spend, trend and forecasting data matters 

When high-cost specialty drugs process on the medical benefit, visibility can be fragmented. Our Medical Pharmacy Trend Report is purpose-built to close that gap — quantifying PMPM, isolating what’s due to utilization versus price mix and projecting forward by line of business and category. 

Additionally, the market is signaling readiness for advanced management. In our 2025 payer survey, 82% of plans review medical and pharmacy together to determine the most cost-effective coverage; 86% allow white bagging for certain medical specialty drugs; and 68% are utilizing value-/outcomes-based agreements — all strategies that become far more precise when informed by integrated utilization and forecasting data. 

Turning data into actionable insights for Crohn’s and UC 

The Medical Pharmacy Trend Report provides a clear view of where spend is concentrated, what’s driving trend and how market events may shift future costs. For Crohn’s and UC, this means: 

• Channel visibility. Data highlights the impact of IV induction and SC maintenance on benefit mix, helping stakeholders understand where costs originate and how migration patterns could influence budgets. 
• Biosimilar adoption signals. Utilization and cost-per-claim metrics show how infliximab biosimilars are reshaping spend, offering insight into potential savings opportunities. 
• Site-of-service benchmarks. CPT-level and place-of-service data reveal cost differences across care settings, informing discussions about efficiency and member experience. 
• Forecasting for market change. Trend components paired with upcoming events — such as Stelara biosimilar launches — equip plans with forward-looking intelligence to anticipate risk and plan for volatility. 

While the report doesn’t dictate strategy, it arms decision-makers with the data they need to evaluate options, model scenarios, and align clinical and financial goals. In short, it turns raw numbers into a roadmap for informed action. 

What to watch next 

• SC migration and adherence. Will Medicare adoption of Entyvio SC accelerate with education and home-administration support? 
• IL-23 class competition. Expect further ripple effects from Skyrizi’s UC expansion and Omvoh’s entry as real-world outcomes accumulate. 
• Biosimilar economics. Stelara biosimilars will test benefit-channel strategies and medical-to-pharmacy coordination in 2025.  

Managing Crohn’s and UC well requires seeing the whole picture of clinical nuance, benefit channel, site of care and forward trend. Prime’s integrated analytics and payer-tested levers translate that picture into action for client budgets and plan members.  

Watch the Medical Pharmacy Trend Report insights webcast for expert analysis on what’s next in medical pharmacy.