EMPLOYER MARKET
INSIGHTS REPORT 2021 FOURTH EDITION
TA B L E O F C O N T E N T S Editorial and Design Staff
EMPLOYER MARKET TRENDS
2
STEPHANIE STEVENS, MPH
TRADITIONAL PHARMACY TRENDS
3
JENNIFER BOSTICK
SPECIALTY PHARMACY TRENDS
4
CLINICAL CASE STUDIES
5
Director, Marketing
Senior Graphic Designer
BROOKE KACHURA Director, Marketing
Contributors EARL HURST
MARK SANTILLI, P harmD
KARIM PRASLA, PharmD
DANNY MELSON
SAGAR MAKANJI, P harmD
KAYLA HIRSCH
Senior Vice President, General Manager, PBM Markets Vice President, Clinical Outcomes, Analytics and Reporting Vice President, Clinical Strategy and Programs
Senior Director, Clinical Strategy and Programs
Senior Analyst, Forecasting and Pharmacoeconomics Vice President, Marketing
KATIE LOCKHART
Manager, Forecasting and Pharmacoeconomics
Forecasting powered by
MRxPredict ©2021 Magellan Rx Management, LLC. Magellan Rx Management 2021 Employer Market Insights Report™. All rights reserved. All trademarks are the property of their respective owners. The content — including text, graphics, images, and information obtained from third parties, licensors, and other material (“content”) — is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Figures may be reprinted with the following citation: “Magellan Rx Management Employer Market Insights Report™, Fourth Edition, ©2021. Used with permission.”
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MAGELLAN RX EMPLOYER MARKET INSIGHTS REPORT / 2021
E M P LOY E R M A R K E T T R E N D S
FIGURE 1: Drug Trend Forecast 2020-2023
FIGURE 2: 2020 Cost Share TRADITIONAL DRUGS
14.4%
Welcome to the 4th edition of the Magellan Rx Employer Market Insights Report.
• Drivers of trend • Impact of prescriber interventions
Falling Trend in 2021; Climbing Trend in 2023 In 2020, as predicted, trend was well managed for traditional, and one of the highest years for specialty. Overall, there was a net positive trend in 2020, with trend forecasted to experience a drop in the next year. In 2022, specialty is expected to see an increased trend on par with 2020 and increase to 14.4% due to pipeline agents across both traditional and specialty categories (see figure 1). The highest impact pipeline agents in 2022 will be immunosuppressive and lupus agents. Lupus will continue to see a high spend forecasted pipeline in 2024 with agents from diabetes and autoimmune - anti-inflammatory impacting spend (see figure 4). In 2020, the flat traditional trend was a result of positive trend in utilization being almost completely negated by decreased trend in unit cost. Positive trend in utilization was exclusively based on volume (consumption). For unit cost, positive trend in inflation and a small increase based in costs of drugs used (drug mix) were not outpaced by decreases in pricing and cost share. This is also illustrated in cost share trends where traditional out of pocket (OOP) costs decreased from $12.92 in 2019 to $11.79 in 2020 (see figure 2). For specialty drugs, cost share and pricing did experience a decreased trend, likely due to an increase in the use of specialty generic agents. But this decline could not offset the increase in utilization and overall effects of inflation and drug mix. Utilization had the largest impact on the 12.8% specialty trend (see figure 3). Due to continued management of traditional drugs, traditional member cost share decreased from 19% in 2019 to 17% in 2020. Although specialty member cost share increased from 5% in 2019 to 6% in 2020, utilization and inflation offset any decrease spend plan sponsors may experience from a slight decrease in cost share burden (see figure 2). Methodology and Disclaimer All forecasts are based on MRx methodology to project financial impact for years 2020, 2021, 2022, and 2023. Forecasting information is for informational purposes only. This report is based on the following methodology: • Specialty drugs include only those covered on the pharmacy benefit and are based on MRx specialty definition. • Cost per claim is based oningredient cost per claim. • Overall drug trend and forecast is based on plan paid per member per month (PMPM) change year over year after rebates and network discounts. • Specialty drug trend and forecast is based on plan paid PMPM change year over year after rebates and network discounts; individual condition drug trend and forecast is prior to rebate impact but includes network discounts. • Traditional drug trend and forecast based on plan paid PMPM change year over year after rebates and network discounts; individual condition drug trend and forecast is prior to rebate impact but includes network discounts. Utilization divided into consumers (utilizers) and consumption (days, supply per utilizer).
9.4%
7.4% 6.5%
5.1%
3.6%
5.6%
1.9%
Member 6%
Pla n
Pla n
or 94% ons Sp
• Three-year forecast • Key conditions to watch
Member 17%
SPECIALTY DRUGS
or 83% ons Sp
The Employer Market Insights Report is a one-of-a-kind report highlighting the key insights that matter to your business. The report gives a view of overall trends and a breakdown of traditional and specialty trends including:
12.8%
1.6% -0.1%
2020
Avg. OOP Cost per Claim $11.79
-1.5% 2021
2022
Traditional
Overall
Avg. OOP Cost per Claim $297.12
2023 Specialty
FIGURE 3: 2020 Drug Trend Drivers 8.0% 5.2%
5.1%
Traditional
2.9% 1.3%
1.0% -0.9% -2.1%
-2.6% Consumers
0.7%
Specialty
-2.1% -3.8%
Consumption
Cost Share
Utilization: Traditional 2.7% Specialty 9.0%
Pricing
Inflation
Drug Mix
Unit Cost: Traditional -2.7% Specialty 3.8%
FIGURE 4: Key Pipeline Products Forecast Pipeline Product
Benefit
2022 PMPM
2023 PMPM
Vynpenta (Transplant/Immunosuppressive Therapy)
Specialty
$0.25
$0.25
Voclosporin (Systemic Lupus Erythematosus (SLE))
Specialty
$0.24
$0.48
Kesimpta (Multiple Sclerosis)
Specialty
$0.20
$0.26
Bimekizumab (Autoimmune - Anti-Inflammatory)
Specialty
$0.10
$0.19
BMS-986165 (Autoimmune - Anti-Inflammatory)
Specialty
Inclisiran (Dyslipidemia)
Specialty
$0.09
$0.10
AXS-05 (Depression)
Traditional
$0.11
$0.24
Tirzepatide (Diabetes)
Traditional
TOTAL
$0.27
$0.28 $0.99
$2.07
MAGELLAN RX EMPLOYER MARKET INSIGHTS REPORT / 2021
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TRADITIONAL PHARMACY TRENDS FORECAST
FIGURE 7: Key Traditional Conditions Trend Forecast 2020-2023
2020
Traditional pharmacy trend is well managed in most years with a negative trend in spend. Forecasted trend is higher in 2022 considering the pipeline agents expected to release that year (see figure 5). As illustrated in figure 4, traditional category depression will see the highest spend increase of $0.11 PMPM with its pipeline agent AXS-05. In 2023, trend will be lower, but will still experience an increase with the continued PMPM spend of Inclisiran and the addition of diabetes agent Tirzepatide, which is anticipated to have $0.28 PMPM spend.
2021
2022
2023
DIABETES 11.5% 7.7% 6.0% 5.0%
Migraine continues to be a condition to watch with some of the highest trends across all categories. Migraine will experience a steady decrease in trend over the next few years, but will continue to be high (see figure 7). Diabetes continues to be the top traditional condition and PMPM will be on a steady incline with anticipated pipeline agents and continued utilization (see figure 6). Diabetes and asthma/COPD are top conditions and also key traditional conditions based on their PMPM trend. The other key conditions for the traditional benefit do not have the highest spend, but have some of the highest trends. The somewhat consistent negative seizure and dyslipidemia agent trends contribute to neutralizing the traditional trend, while “condition to watch” migraine, along with depression, contribute to the positive side of trend (see figure 7).
ASTHMA/COPD 5.9% 0.2% 8.4% 6.5%
SEIZURE FIGURE 5: Traditional Trend Forecast 2020-2023
-20.6%
FIGURE 6: Top Traditional Conditions PMPM Forecast 2020-2023
-2.0%
5.6%
$2.16 $2.37 $3.12 $5.32
1.6% -0.1% 2020
$2.02 $2.35 $3.94 $5.33
0.4%
$1.36
$2.03
-2.0%
$2.42
$2.39
$5.42
$4.69
$6.16
$5.78
Attention Deficit-Hyperactivity Disorder (ADHD) Hypertension
$16.56
$17.56
$18.44
2020
2021
2022
2023
Asthma/COPD
43.2% 31.7% 22.6%
Diabetes
-1.5% 2021
69.4%
Top Condition to Watch
Anti-Clotting Therapy
$15.38
MIGRAINE
DYSLIPIDEMIA 2022
2023
-8.2% 0.8% -13.0% -5.3%
2020 OOP per Claim
$24
$7
$47
$24
$29
Attention DeficitHyperactivity Disorder (ADHD)
Hypertension
Anti-Clotting Therapy
Asthma/COPD
Diabetes
DEPRESSION 1.6%
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MAGELLAN RX EMPLOYER MARKET INSIGHTS REPORT / 2021
-3.8%
2.7% 5.4%
S P E C I A LT Y P H A R M A C Y T R E N D S F O R E C A S T
FIGURE 11: Key Specialty Conditions Trend Forecast 2020-2023
Specialty pharmacy trend continues to be high single or double digits. Costs of specialty medications and restrictions on management of these agents will dictate a positive trend in the benefit for the foreseeable future (see figure 9). Like traditional, pipeline agents in 2022, will bump up the specialty trend, accounting for 89% of the eight key pipeline products and almost doubling trend year over year. As illustrated in figure 4, the trend will decrease in 2023 and pipeline agents will make up 75% of key pipeline products with the inclusion of an additional autoimmune product.
2020
2021
14.4%
$1.33 $1.31 $2.94 $3.49
2021
12.0% 14.7% 12.9% 11.2%
$2.84 $3.38
$3.12 $3.43 $7.18
$16.95
HIV/AIDS
$3.29 $3.45
Cystic Fibrosis
$7.65
HIV/AIDS
4.3% -3.1% 9.4% 5.5%
Multiple Sclerosis
$7.46
Oncology
$20.75
$25.54
$26.66
Autoimmune Anti-inflammatory
MULTIPLE SCLEROSIS -0.8%
7.4% 2020
4.9%
ONCOLOGY
$1.89
$6.50
9.4%
21.5% 22.4% 23.1%
Top Condition to Watch
FIGURE 10: Top Specialty Conditions PMPM Forecast 2020-2023
$1.70
12.8%
2023
AUTOIMMUNE - ANTI-INFLAMMATORY
Pursuant to the robust pipeline and lending itself to a significant trend, autoimmune - anti-inflammatory is the top PMPM spend category as well as the category to watch. Amongst key conditions, autoimmune has the highest trend, often close to twice that of oncology, the second highest PMPM spend category (see figure 11). It should be noted the autoimmune trend will decrease significantly in 2023 from an average 22% trend to a 5% trend due to the introduction of biosimilars for Humira. Even so, autoimmune - anti-inflammatory will constitute up to a quarter of specialty spend on the pharmacy benefit. In 2020, the category makes up 19% of total spend and will increase to 25% by 2023. FIGURE 9: Specialty Trend Forecast 2020-2023
2022
-3.5% 2022
2023
2020
2021
2022
1.8%
2023
0.5%
2020 OOP per Claim
$426
$55
$411
$191
$378
Autoimmune Anti-inflammatory
Oncology
Multiple Sclerosis
HIV/AIDS
Cystic Fibrosis
MAGELLAN RX EMPLOYER MARKET INSIGHTS REPORT / 2021
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CLINICAL CASE STUDIES
DRIVING CLINICAL IMPROVEMENT THROUGH TARGETED PRESCRIBER INTERVENTIONS Magellan Rx Management deploys a variety of algorithms to identify and communicate member-specific opportunities to improve the overall quality of care. Below are four categories displaying the impact of these interventions on outcomes.
ASTHMA Background Members with sub-optimal control of their asthma are more likely to require urgent care in the form of emergency visits or hospitalizations.
STATINS FOR PRIMARY PREVENTION Results
~2x
Goal
increase in utilization of controller medications
Identify members with sub-optimal asthma control and promote utilization of long-acting controller medications to improve overall quality of care.
~22%
reduction in spend on rescue asthma medications
MIGRAINE PREVENTION Background Prophylactic treatment has been shown to decrease the frequency and severity of migraines, while also improving clinical outcomes and quality of life.
Goal Identify members with high utilization of acute migraine treatment that may benefit from the addition of a prophylactic medication to improve migraine control.
5
Background The American College of Cardiology (ACC), American Heart Association (AHA), and the American Diabetes Association (ADA) recommend treatment with a statin medication for patients with diabetes to help protect against cardiovascular events such as heart attacks and strokes.
Results
> 4x
increase in the number of diabetic members on statin therapy
Goal Increase utilization of statin therapy among members with diabetes between 40 to 75 years of age.
OPIOIDS WITH POTENTIATOR MEDICATIONS Results
Background
Results
members on migraine prophylaxis therapy
Members prescribed opioids with potentiator medications, such as skeletal muscle relaxants (SMRs) and benzodiazepines, are at an increased risk for adverse events.
18%
reduction in utilization of SMRs
Goal
13%
NEARLY DOUBLING
~35%
reduction in spend on acute migraine treatment
MAGELLAN RX EMPLOYER MARKET INSIGHTS REPORT / 2021
Identify members concurrently on opioids and SMRs/benzodiazepines that may benefit from discontinuation of one or more potentiators.
reduction in utilization of benzodiazepines
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MAGELLAN RX EMPLOYER MARKET INSIGHTS REPORT / 2021
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