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Magellan's report is the only benchmark of its kind for drugs paid under the Medical Benefit
"The pharmacy benefit management industry continues to evolve as it
analyzes and provides solutions to the most complex drug utilization on
the medical benefit," said
Among the key findings in the 2013 Medical Pharmacy Trend Report:
Twenty-two percent of plans indicated that they had a medical
formulary in place. Of that 22 percent:
- 94 percent indicated they used prior authorization
- 31 percent indicated that they had reimbursement strategies in place
- 31 percent indicated they used pathways
- 25 percent indicated they used tiered benefit structures
- 25 percent indicated that they had a policy in place
- Genetic testing remains a critical component of medical drug management, but plans have not yet developed sophisticated strategies to help manage this trend.
- Only 31 percent of plans responded said they receive rebates on the medical benefit, down from 57 percent. However, plans did say they are receiving rebates in some new categories like hemophilia, intravenous immunoglobulin (IVIG) and cancer.
- Fifty-six percent of plans implemented a fixed fee schedule to reduce the number of hospitals being reimbursed for medical drugs on a percentage basis. The shift to hospital site-of-service for medical drugs remains a significant driver of trend.
- The top cancer medications increased in hospital utilization by 20-35 percent, with the majority of this utilization shifting from the physician's office.
"In recent years, we've seen very minimal trends for traditional oral pharmacy products as compared to specialty products, where trends are in the double digit range for self-administered injectables and continue to trend upward on provider-administered products," said Kamal. "This trend will continue to prevail, driven by a robust specialty pipeline, paired with continued patent expiration of traditional oral medications. Specialty products represent 25-30 percent of total drug spend, while medical benefit injectables represent approximately 15 percent of total drug spend. Specialty drug spend will continue to grow at a faster rate than traditional oral drugs, and is on pace to make up approximately 50 percent of total drug cost in the next five years."
The fourth annual Medical Pharmacy Trend Report is available online. The report employs a combination of primary and secondary research methodologies to deliver a comprehensive view of payor perceptions and health plan actions related to medical injectables, including those used for chemotherapy and cancer supportive care, rheumatology and immunotherapy.
Magellan Rx Management includes a complete suite of industry-leading
pharmacy offerings, consisting of pharmacy benefit management,
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