Highlights From The Prime Therapeutics Drug Trend Report

It’s been a busy year, and I’m getting a late start on reviewing the drug trend reports as I’ve done in the past. I’ll try to get to the CVS Caremark and Express Scripts reports next week.

As I mentioned last year, the Prime Therapeutics Drug Trend Report takes a more aggressive stand and how they compare to the competition. I’ll give a lot of that credit to Eric Elliot’s presence there as the CEO.

“Smart car buyers know that the actual cost of a car does not always align with the price on the window; the same is true for pharmacy benefits. Yet plan sponsors continually focus on “sticker price” measures such as brand-name discounts or manufacturer rebates — metrics that can be manipulated to make a deal look more attractive.”

The one thing which is noticeably different this year is that the document has more of a care management sound to some of the programs they talk about with an emphasis on total healthcare cost savings. Again, I attribute that to both being owned by the Blues and having several people in the management team that came from payers. Buried towards the back, they call themselves “total health focused” versus their competitors.

As always, here’s a few things that caught my attention:

• A $4.73:$1 ROI for using the local pharmacist to address gaps-in-care.
• 1.3% trend increase.
• 74.7% generic fill rate.
• 20.1% specialty trend increase.
• 15.4% of client’s pharmacy spend is for specialty drugs which cost on average $2,654.
• 0.4% of Rx claims processed are for specialty drugs.
• Their Rxs PMPY have gone up to 12.4 which I think is closer to industry.
  • This is an interesting one. I pointed out a few years ago that they were below average which I wasn’t sure if this was due to plan design, member mix, or client mix.
  • They seem to be going up even though some industry data suggests a downturn in Rxs filled which again is something I can’t explain.
  • It could simply be more people >50 years old are staying in the insured mix…and they use more drugs.

• Their average net costs per Rx were:
  • $165.33 brand
  • $17.95 generic
  • $57.53 combined
• They breakdown specialty spend by category and also show how it’s growing and is projected to grow as a percentage of total drug spend.

• Of course, another big piece of the specialty picture is how the spend breaks out between medical and pharmacy benefits. This is why blending data to understand the complete picture is important.

• I thought the list of specialty drug management tools was a good starting point although I expected to see more here about how to integrate with the payers especially around categories like oncology and what BCBS of Florida is doing around an oncology ACO solution.