This week, I’m rerunning some popular posts while I work on the forthcoming 2017-18 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. Click here to see the original post and comments from March 2017.
ICYMI, I published a follow up analysis that includes OptumRx in Which PBM Best Managed Drug Spending in 2016: How Did OptumRx Compare?
Four of the largest pharmacy benefit managers (PBMs)—CVS Health, Express Scripts, MedImpact, and Prime Therapeutics—have raised their swords and released their 2016 drug trend reports. (Links below.) That means it’s time for some Drug Channels-style fun! Below, I review what the reports reveal about drug spending—and which questions remain unanswered.
Drug trend measures the year-over-year changes in a plan sponsor’s pharmacy benefit drug spending. As you will see, all four PBMs reported that their drug trend percentages for 2016 were in low single digits. The unweighted average among them was a mere 3.5%. About one-third of PBM clients experienced year-over-year declines in drug spending.
Put more simply: The U.S. doesn’t have a drug spending problem. It's fake news.
Specialty drugs have doubled as a share of plan sponsors’ benefit costs. Since these products account for only about 1% of claims, pharmacy benefit management is increasingly focused on handling these patients and their complex, hard-to-treat diseases. Unfortunately, payers seem set on discriminating against people who receive these therapies.
Keep in mind that the PBMs’ reports are primarily marketing documents, not peer-reviewed research studies. But as many PBM executives have said: What we do in life echoes in eternity!
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