INSIGHTS REPORT 2022 FIFTH EDITION
TA B L E O F C O N T E N T S Editorial and Design Staff
EMPLOYER MARKET TRENDS
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STEPHANIE STEVENS, MPH
TRADITIONAL PHARMACY TRENDS
3
JENNIFER BOSTICK
SPECIALTY PHARMACY TRENDS
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Director, Marketing
Senior Graphic Designer
Contributors EARL HURST
Senior Vice President, General Manager, PBM Markets
CHRISTOPHER SALIBA, PharmD, MBA Vice President, Clinical Account Management
KARIM PRASLA, PharmD, MS, BCPS Vice President, Clinical Outcomes, Advanced Analytics and Research
KATIE LOCKHART, MA
Manager, Forecasting and Pharmacoeconomics
Forecasting powered by
MRxPredict ©2022 Magellan Rx Management, LLC. Magellan Rx Management 2022 Employer Market Insights Report™. All rights reserved. All trademarks are the property of their respective owners. The content — including text, graphics, images, and information obtained from third parties, licensors, and other material (“content”) — is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Figures may be reprinted with the following citation: “Magellan Rx Management Employer Market Insights Report™, Fifth Edition, ©2022. Used with permission.”
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MAGELLAN RX EMPLOYER MARKET INSIGHTS REPORT / 2022
E M P LOY E R M A R K E T T R E N D S Welcome to the 5th edition of the Magellan Rx Employer Market Insights Report. The Employer Market Insights Report is a one-of-a-kind publication highlighting the key insights that matter to your business. The report gives a view of overall trends and a breakdown of traditional and specialty trends including: Three-Year Forecast
Key Conditions to Watch
Drivers of Trend
Illustration of Prescriber Interventions
Well Managed Trend by 2024 Trend for 2021 and forecasted trend for 2022 are expected to be net positive with traditional experiencing a negative or minimal positive trend, and specialty trending between 4-7%. There is a projected shift with specialty trend having a significant drop of almost 1% in 2023 and 3% in 2024 where historically this trend has been in double digits. This unprecedented shift in specialty is due to the introduction of multiple biosimilars. This shift can also be seen in the pipeline. Per member per month (PMPM) for the traditional pipeline is expected to outpace specialty in both 2023 and 2024 primarily due to the anticipated growth of Tirzepatide, which was only recently approved. Drivers of the drug trend paralleled the beginnings of this changing story with the overall increase in utilization, but reduction in unit cost. Utilization of specialty medications did not slow, with a 7% increase in utilization in 2021, but due to continued cost containment measures saw a 3.4% reduction in unit costs. Utilization of traditional drugs was minimal, and that benefit continued to see reduction in unit costs creating an almost neutral, if not negative, drug trend. Drug Trend Forecast 2021-2024 Traditional
Overall
Specialty
2021 Drug Trend Drivers Traditional
Key Pipeline Products Forecast
Specialty Pipeline Product
7.7%
6.6%
1.3%
-0.5%
2.2%
-1.6%
1.1%
-0.8%
-0.6%
2023
2024
Consumers
Consumption
2.7% 0.0%
-2.2%
-3.4%
-3.9%
-3.0% 2022
0.9%
0.3%
0.2%
2021
3.1%
4.5%
1.1%
2023 PMPM
2024 PMPM
Traditional
4.4%
4.4%
Condition
-5.2%
Cost Share
Utilization Total: Traditional 0.5% Specialty 6.9%
Pricing
Inflation
Drug Mix
Unit Cost Total: Traditional -2.1% Specialty -2.5%
Tirzepatide
Diabetes
$0.44
$1.09
AXS-05
Depression
$0.18
$0.28
Tezepelumab
Asthma/COPD
$0.17
$0.27
Sage-217
Depression
$0.13
$0.22
Mavacamten
Cardiovascular - Other
$0.02
$0.03
$0.95
$1.90
TOTAL (Traditional) Specialty Bimzelx
Autoimmune - Anti-inflammatory
$0.19
$0.33
BMS-986165
Autoimmune - Anti-inflammatory
$0.17
$0.41
Methodology and Disclaimer All forecasts are based on Magellan Rx methodology to project financial impact for years 2021, 2022, 2023 and 2024. Forecasting information is for informational purposes only. Forecasting assumes the adoption of biosimilar drugs, however, there is considerable uncertainly around approval timeline and interchangeability status. Therefore, this data does not reflect Magellan Rx Management’s decision on how to maximize the savings that will be potentially achieved with the introduction of the biosimilars. This report is based on the following methodology:
Leqvio
Dyslipidemia
$0.14
$0.17
Tlando
Hormone Therapy
$0.12
$0.12
Cibinqo
Dermatological - Other
$0.06
$0.09
• Specialty drugs include only those covered on the pharmacy benefit and are based on MRx specialty definition.
Traditional
Overall
Specialty
Lebrikizumab
Dermatological - Other
$0.04
$0.09
• Overall drug trend and forecast is based on plan paid per member per month (PMPM) change year over year after rebates and network discounts.
Adagrasib
Oncology
$0.01
$0.03
• Specialty drug trend and forecast is based on plan paid PMPM change year over year after rebates and network discounts; individual condition drug trend and forecast is prior to rebate impact but includes network discounts.
TOTAL (Specialty)
$0.73
$1.24
• Traditional drug trend and forecast based on plan paid PMPM change year over year after rebates and network discounts; individual condition drug trend and forecast is prior to rebate impact but includes network discounts. Utilization divided into consumers (utilizers) and consumption (days, supply per utilizer).
TOTAL
$1.68
$3.13
• Cost per claim is based on average wholesale price (AWP); cost = employer liability after cost share.
MAGELLAN RX EMPLOYER MARKET INSIGHTS REPORT / 2022
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TRADITIONAL PHARMACY TRENDS FORECAST Traditional pharmacy trend was well managed in 2021. The robust traditional pipeline, specifically in diabetes, is forecasted to cause a slight increase in trend, but trend will remain below 3% over the next three years. The diabetes pipeline peaked in 2021 and will slow over the next three years, but will remain a double-digit trend slowing to slightly below 10% in 2024. While the trend may slow for diabetes, the PMPM will increase by 2024, accounting for 60% of PMPM for the top traditional categories. Migraine is still a key condition on the traditional benefit with an almost double trend (49%) in 2021. The trend will decrease significantly over the next three years to almost 20%, but remains the key category with the highest trend. Top Traditional Conditions PMPM Forecast 2021
-1.6%
2023
DIABETES
ASTHMA/COPD
ANTI-CLOTTING THERAPY
HYPERTENSION
Asthma/COPD
Seizure
Migraine
Dyslipidemia
Depression
50 40 30
Top Condition to Watch
20 10 0 -10 -20
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2021
MAGELLAN RX EMPLOYER MARKET INSIGHTS REPORT / 2022
2022
2023
$0.96
$1.17
ATTENTION DEFICITHYPERACTIVITY DISORDER (ADHD)
Key Traditional Conditions Trend Forecast Diabetes
$1.80
$1.84
$2.04
$2.00
$1.98
$1.99
$4.61
$4.16
$3.76
$3.39
$6.04
2024
$6.15
2023
$19.02
2022
$17.16
1.1%
$5.93
2021
1.1%
$15.32
2.2%
2022
$20.87
2020
$6.09
Trend Forecast
2024
S P E C I A LT Y P H A R M A C Y T R E N D S F O R E C A S T Specialty pharmacy trend will see a significant shift over the next few years with an unprecedented negative trend in 2023 and 2024. Although there remains some uncertainty around the anticipated introduction and adoption of biosimilars in 2023, our forecasting assumption based on the shift to biosimilars is expected to make a huge impact to the pharmacy benefit, moving from its normal double digit trend to a negative 0.8% and negative 3% trend in 2023 and 2024, respectively. Contributing to this trend is the reduction in unit cost across the board for the top specialty conditions. Most significant is the reduction in trend for Autoimmune: Anti-inflammatory drugs which will see a 13.3% decrease in gross PMPM spend in 2023, contingent on uptake of biosimilars.
Top Traditional Conditions PMPM Forecast 2023
-3.0%
AUTOIMMUNE: ANTI-INFLAMMATORY
CYSTIC FIBROSIS
HIV/AIDS
MULTIPLE SCLEROSIS
$1.90
$1.74
$1.58
$1.34
$2.00
$2.01
$2.01
$1.97
$1.32
$1.58
$2.01
-0.8%
$2.33
$6.04
2024
$6.15
2023
$6.09
2022
2022
$5.93
2021
2021 $18.69
$18.92
4.4%
$21.57
2020
7.7%
$17.61
Trend Forecast
ONCOLOGY
Key Specialty Conditions Trend Forecast Autoimmune: Anti-inflammatory
Oncology
HIV/AIDS
Multiple Sclerosis
Top Condition to Watch 20 15 10 5 0 -5 -10 -15 -20 -25
2021
2022
2023
2024 MAGELLAN RX EMPLOYER MARKET INSIGHTS REPORT / 2022
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MAGELLAN RX EMPLOYER MARKET INSIGHTS REPORT / 2022
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