Senior Vice President, General Manager, PBM Markets
KARIM PRASLA, P harm D Vice President, Clinical Outcomes, Analytics and Reporting
SAGAR MAKANJI, P harm D Vice President, Clinical Strategy and Programs
KATIE LOCKHART Manager, Forecasting and Pharmacoeconomics
MARK SANTILLI, P
Senior Director, Clinical Strategy
DANNY MELSON Senior Analyst, Forecasting and Pharmacoeconomics
KAYLA HIRSCH Vice President, Marketing
EMPLOYER MARKET TRENDS
Welcome to the 4th edition of the Magellan Rx Employer Market Insights Report.
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:
• Three-year forecast
• Key conditions to watch
• 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 fgure 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-infammatory impacting spend (see fgure 4).
In 2020, the fat 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 infation 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 fgure 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 ofset the increase in utilization and overall efects of infation and drug mix. Utilization had the largest impact on the 12.8% specialty trend (see fgure 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 infation ofset any decrease spend plan sponsors may experience from a slight decrease in cost share burden (see fgure 2).
Methodology and Disclaimer
All forecasts are based on MRx methodology to project fnancial 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 beneft and are based on MRx specialty defnition.
• 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
FIGURE 1: Drug Trend Forecast 2020-2023
FIGURE 4: Key Pipeline Products Forecast
FIGURE 3: 2020 Drug Trend Drivers
FIGURE 2: 2020 Cost Share
TRADITIONAL PHARMACY TRENDS FORECAST
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 fgure 5). As illustrated in fgure 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.
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 fgure 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 fgure 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 beneft 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 fgure 7).
FIGURE 5: Traditional Trend Forecast 2020-2023
FIGURE 7:
SPECIALTY PHARMACY TRENDS FORECAST
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 beneft for the foreseeable future (see fgure 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 fgure 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.
Pursuant to the robust pipeline and lending itself to a signifcant trend, autoimmune - anti-infammatory 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 fgure 11). It should be noted the autoimmune trend will decrease signifcantly in 2023 from an average 22% trend to a 5% trend due to the introduction of biosimilars for Humira. Even so, autoimmune - anti-infammatory will constitute up to a quarter of specialty spend on the pharmacy beneft. In 2020, the category makes up 19% of total spend and will increase to 25% by 2023.
FIGURE
FIGURE
CLINICAL CASE STUDIES
DRIVING CLINICAL IMPROVEMENT THROUGH TARGETED PRESCRIBER INTERVENTIONS
Magellan Rx Management deploys a variety of algorithms to identify and communicate member-specifc 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.
Goal
Identify members with sub-optimal asthma control and promote utilization of long-acting controller medications to improve overall quality of care.
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 beneft from the addition of a prophylactic medication to improve migraine control.
NEARLY DOUBLING
STATINS FOR PRIMARY PREVENTION
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.
Goal
Increase utilization of statin therapy among members with diabetes between 40 to 75 years of age.
increase in the number of diabetic members on statin therapy
reduction in utilization of SMRs reduction in spend on rescue asthma medications
~2x > 4x 18% ~22% ~35% 13% increase in utilization of controller medications members on migraine prophylaxis therapy
reduction in spend on acute migraine treatment
OPIOIDS WITH POTENTIATOR MEDICATIONS
Background
Members prescribed opioids with potentiator medications, such as skeletal muscle relaxants (SMRs) and benzodiazepines, are at an increased risk for adverse events.
Goal
Identify members concurrently on opioids and SMRs/benzodiazepines that may beneft from discontinuation of one or more potentiators.
