Those who remain script 201911/12/2022 How to manage pharmacy-billed specialty drug trend and costs This indicates that the market is expecting a rebound of visits and specialty patients to come, which could continue to drive up specialty drug trend. For example, oncology patient doctor visits declined approximately 20% for some of 2021, while cancer screenings also significantly declined (mammograms by 87%, colonoscopies by 90% and pap smears by 83%). 1 For most patients, these are life-sustaining, and even life-saving therapies, which presents the challenge of balancing affordability with the access to care.Īdditionally, plans will continue to be impacted from the COVID-19 pandemic and delayed care resulting in delayed diagnoses of specialty conditions. That is 75x more to cover a specialty patient over the course of a year. Since specialty medications typically impact drug trend the most addressing the high cost of specialty medication is crucial.Īt a member level, plan sponsors see an average annual cost of $38,000 to cover a specialty patient’s drugs compared to just $492 for the coverage of a non-specialty patient’s costs. The impact of specialty drug trend and spendĮven though less than 2% of the population uses specialty drugs, those prescriptions account for a staggering 51% of total pharmacy spending 1. Utilization trend is the rate of change in total days’ supply of medication dispensed across all prescriptions and a good indicator of adherence. Unit cost trend is the rate of change in unit costs due to the combined impact of inflation, discounts and drug mix. Typically, drug trend for plan sponsors is broken out into two components: unit cost trend and utilization trend. Total drug costs represent the total cost of the medication (ingredient costs, taxes, dispensing fee and administrative fees) paid per person by plan sponsors and plan members. What is drug trend and how is it calculatedĭrug trend is calculated as the percentage change in total drug costs from one year to the next. Controlling drug trend every year is always a high priority for plan sponsors who are looking for ways to make access to medications more affordable for their plans and their members.
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