Prime Therapeutics Drug Trend Report

By February 28, 2017Commentary

Prime Therapeutics gives us a peek at its drug trend, via a press release.  Maybe a full report will follow.   (Prime Release)  Prime is owned by a number of Blue Cross Blue Shield plans and they represent most of its customer base.  It is currently probably the fourth largest PBM by number of people served, almost 20 million, and has a very extensive commercial business.  It says it had a 2.5% increase in drug spending in 2016 (unclear if this is on a per capita basis).  Specialty drug spending rose 13.7%, while traditional drug trend was a negative 1.7%.  The company claims its various management tools saved clients $2.2 billion.  Use of generics rose from an already high 83.1% in 2015 to 84.7% in 2016.  Prime also highlighted growing use of preferred pharmacies and continued emphasis on certain diseases and drug categories.  Diabetes and biologic anti-inflammatory drugs were highlighted as a major source of greater spending.  Diabetes drugs account for 13% of all medication spending, and rose 18% on the back of a 10% increase in price and 6% increase in utilization.  A care management program used by Prime was said to have reduced the trend to 7.5%.  Anti-inflammatory drugs used for arthritis and other diseases accounted for 10% of all drug spending and 40% of specialty drug expenses in 2016.  Prime noted its efforts to manage specialty drug spend across the medical and pharmacy benefits, which can be important as many infused and other specialty drugs end up being paid for outside of pharmacy benefits.

Author Kevin Roche

The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry through Roche Consulting, LLC. Mr. Roche is available to assist health care companies through consulting arrangements and may be reached at khroche@healthy-skeptic.com.

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