Commercial plans realize the lowest drug spend to date — with only a 1.6 percent increase
In spite of rising drug prices for established drugs and blockbuster innovator drugs, MedImpact achieved record-low drug trend across commercial, Medicare and Medicaid health plans in 2017. Commercial plans saw the lowest trend increase – just 1.6 percent compared to 2.9 percent in 2016. Specialty drugs, those that usually require special handling, close monitoring and complex administration, incurred a trend of 10.2 percent for commercial plans in 2017. Specialty products represented only 1 percent of claim volume, but accounted for 41 percent of total spend.
With the impact of recent merger and acquisition activities and high-impact, high-cost specialty and orphan drugs dominating the drug pipeline, plan sponsors contend with numerous, competing market dynamics impacting budgets across both the pharmacy and medical benefits, including:
- A move toward vertical integration as health plans acquire PBMs or PBMs acquire health plans
- Market entry of high-cost, innovative specialty and orphan drugs
- Incorporation of real-world evidence in the Food and Drug Administration (FDA) drug approval process
- Renewed debate over value, reimbursement, access and eligibility for costly but highly effective cell-based therapies, gene therapies and regenerative medicines
The Annual Trend Report details MedImpact’s success at managing trend in the face of rising drug costs, providing critical data and industry insights and advanced trend management strategies to help drive low-net cost.
By providing the right drug at the right time to the right member, MedImpact focuses on managing appropriate utilization without driving up utilization. With a strategy sharply focused on payer alignment, MedImpact creates value and drives low-net cost through a differentiated model.
Whereas other PBMs — and their newly formed relationships with plans — drive oversupply through their owned (or will be owned) specialty and mail-order pharmacies, MedImpact’s unique business model takes a conservative approach to fulfillment by providing oversight between the prescriber and the fulfillment pharmacy to better align dispensing with plan formulary and utilization management rules.
In the midst of the industry’s recent merger and acquisition consolidation activities, MedImpact—which will be the largest, trend-focused, privately-held PBM in the nation once transactions have closed — has a continued commitment to remaining independent.
“Merger integration often causes a disruptive impact to the business of healthcare. Member service and access to affordable medications can decline — something we work very hard to prevent every day,” explains Greg Watanabe, MedImpact President and Chief Operating Officer. “Our focus on low-net cost, clinical quality, rigorous utilization management and clinically appropriate formulary drugs — rather than rebate dollars — allows us to align with our clients to deliver lower-cost, quality care.”
About MedImpact
MedImpact, an independent, trend-focused pharmacy benefit manager (PBM), is the nation’s largest privately held PBM, serving health plans, self-funded employers and government entities. Our unique business model aligns us with our clients. We focus on effectively managing pharmacy benefits to promote Lower Cost and Better Care through One Source. We promote the prescribing and fulfillment of low-cost, medically appropriate drugs at the most appropriate pharmacy providing competitive pricing, good value and high-quality service. Our number-one goal is client satisfaction by providing flexible solutions and member-centric products with a focus on low-net cost and quality outcomes. Learn more at pbm.medimpact.com.
