What’s new in Medical Pharmacy trends?

The industry-leading source for Medical Pharmacy trends, benchmarks, strategies, and insights.

PMPM Trend

Historically, the norm was a year-over-year PMPM trend ranging from 6% to 17% across all three lines of business. In 2020 to 2021, the impact of COVID and biosimilars resulted in much smaller trends of 3.2%, 2.7%, and 0% for commercial, Medicare, and Medicaid, respectively.

Top Drug Spend Trend

The top 20 medical benefit drugs had spend trends of 30% or greater, driven by utilization increases for commercial and Medicare, and driven evenly by both cost and utilization for Medicaid.

Oncology Trend

Oncology, a top concern for all surveyed plans, continued to be the top spend category, accounting for 39%, 53%, and 27% of commercial, Medicare and Medicaid spend, respectively.

Biosimilars Trend

Since 2019, oncology biosimilars have contributed to a dramatic estimated 7% reduction in total oncology PMPM spend for commercial markets, as well as 1.6% and 0.5% reductions in Medicare and Medicaid markets, respectively.