Report Highlights Need for Innovative Strategies Around
Difficult-to-Manage Medical Pharmacy Area
SCOTTSDALE, Ariz.--(BUSINESS WIRE)--
Magellan Rx Management, the pharmacy benefit management (PBM) division
Health, Inc. (NASDAQ: MGLN), today released its sixth annual Medical
Pharmacy Trend Report, which includes data from 59 commercial payers
representing approximately 130 million covered lives. In addition, the report
includes an in-depth analysis of various health plans' commercial and
Medicare medical-paid claims data representing utilization across all
outpatient sites of service, including physician offices, home infusion
providers, specialty pharmacies and hospital outpatient facilities. Magellan
Rx Management's Medical Pharmacy Trend Report continues to be the
only publication of its kind to analyze high-cost injectable drugs paid
under the medical benefit.
Key findings in the report
Commercial per-member-per month (PMPM) allowed amounts of $23.60 and
Medicare PMPM allowed amounts of $44.84 increased 11 and 5 percent,
respectively, driven by inflation, utilization, drug mix and shifts in
site of service.
The top 25 drugs by health plan spend cost $22,423 per patient per
year for commercial and represented 64 percent of spend, while the top
25 drugs by Medicare spend cost $10,551 per patient per year and
represented 69 percent of spend.
Although not always included on the top 25 drug listing by overall
payer spend, the annual cost per patient per year across the top 10
most expensive agents averaged $353,000 for commercial and $271,000
for Medicare. These patients represented 0.02 percent of commercial
and 0.04 percent of Medicare members.
Commercial medical benefit drug costs in the hospital outpatient
setting were often double that of the physician office. Compared to
the commercial population, Medicare saw much larger shifts in site of
service from the physician office setting to the hospital outpatient
facility since 2010, especially for oncology and biologic drugs for
autoimmune disorders. Oftentimes, administrative code reimbursement is
four times more expensive in the hospital than physician office
setting for commercial members; for Medicare, it is frequently twice
as costly in the hospital.
"It's no surprise that the trends we've seen for more than five years
now are continuing," said Casandra Stockman, Pharm.D., vice president of
medical pharmacy strategy at Magellan Rx Management. "Fifty
provider-administered agents are driving 80 percent of medical pharmacy
drug spend. This trend has been exacerbated by manufacturer price
increases and site of service shifts from the physician's office to
hospital outpatient settings, particularly as hospital systems purchase
office-based practices. Going forward, we expect to see newer, costly
oncology drugs enter the top 25 drug listing, particularly programmed
cell death 1 (PD1) and programmed death-ligand 1 (PD-L1) inhibitors."
"Medical pharmacy spend can be challenging for health plans to track and
even harder to manage," said Adam Wiatrowski, senior vice president and
general manager of Magellan Rx Management's specialty business. "This is
a key area of focus for payers, and while other PBM firms are just
beginning to delve into this area, Magellan Rx Management has been doing
so for over a decade. Our clinical experts and thought leaders devise
cutting-edge strategies to help manage this critical area to help
provide better care to members while lowering costs for clients."
About Magellan Rx Management: Magellan Rx Management is a
full-service PBM that specializes in solving complex pharmacy challenges
for its customers by developing and executing smart solutions that
leverage industry-leading experience and technology to exceed
expectations across the employer, third-party administrator, broker,
managed care, government, Medicaid and Medicare Part D lines of
business. As a pioneer in medical specialty pharmacy management and a
leader in best-in-class formulary optimization programs, Magellan Rx
Management delivers consistent, proven cost savings. As clinical
experts, Magellan Rx Management delivers customized programs to address
clients' most pressing clinical challenges, drive STAR improvements and
engage patients and providers to deliver improved health outcomes.
About Magellan Health: Headquartered in Scottsdale, Ariz., Magellan
Health, Inc. is a leader in managing the fastest growing, most
complex areas of health, including special populations, complete
pharmacy benefits and other specialty areas of healthcare. Magellan
develops innovative solutions that combine advanced analytics, agile
technology and clinical excellence to drive better decision making,
positively impact health outcomes and optimize the cost of care for the
members we serve— all within a customer-first culture. Magellan's
customers include health plans and other managed care organizations,
employers, labor unions, various military and governmental agencies and
third-party administrators. For more information, visit MagellanHealth.com.
View source version on businesswire.com: http://www.businesswire.com/news/home/20160218006061/en/
Magellan Health, Inc.
Renie Shapiro Silver, 877-645-6464
Source: Magellan Health, Inc.
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