EAGAN, Minn. – Today, Prime Therapeutics LLC (Prime) introduced its 14th annual Medical Pharmacy Trend Report™ (formerly the Magellan Rx Management Medical Pharmacy Trend Report), featuring a holistic view of provider-administered medical benefit drug trends. 

The Medical Pharmacy Trend Report is the industry’s premier comprehensive resource that offers detailed analysis of medical benefit drug claims, data benchmarks and current medical benefit drug management strategies. Its three-year forecast by therapeutic class helps payers anticipate evolving trends to make data-informed decisions related to formulary placement, utilization management and cost mitigation strategies. 

“Over half of today’s drug spend occurs on the medical benefit,” said Steve Cutts, senior vice president, specialty and clinical solutions at Prime. “Therefore, it is critical to fully understand trends in medical pharmacy. Prime’s deep expertise and robust analytics in this area — including variations across lines of business and sites of administration — provide the complete picture of medical drug spend required to create comprehensive specialty management strategies that reduce cost and improve outcomes for patients.”

Report highlights

PMPM trend increase across all lines of business
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.

“Prime’s widely recognized report is set apart by its payer survey integrated with claims data,” said Lisa Polakowski, PharmD, medical benefit drug trend report director at Prime. “Our differentiated survey data shows payers’ top concerns around medical benefit drug management and health plan cost management strategies and how that is reflected within the data.” 

Read more insights from the report.

This report is the cornerstone of Prime’s holistic specialty expertise. With unmatched experience, Prime takes a comprehensive approach to medical benefit drugs. Prime manages whole-person health and looks at insights across the medical benefit — in addition to the pharmacy benefit — to address 100% of management opportunities. 

For a deeper dive into the Medical Pharmacy Trend Report findings, join Polakowski and fellow Prime report authors Laura Walters, RPh, director, specialty clinical solutions, Kristen Reimers, RPh, senior vice president, specialty clinical solutions and Ben Messerli, ASA, MAAA, manager, actuarial services, at 1–2 p.m. ET on Oct. 24. Discussion will center on overall medical pharmacy trends, oncology and insights from Prime’s payer survey. 

Register for the Medical Pharmacy Trend Report webinar.