2018 Drug Trend Report

In 2018, our PBM solutions reduced the impact of price growth to 1.2 percent. Trend was largely driven by utilization increases and adherence improvements. We also kept drugs affordable for members – two out of three utilizing members spent less than $100 on their prescriptions in 2018. That helped more people reach optimal adherence to their prescribed drug regimens in key categories like cholesterol, depression, and diabetes. Our analysis indicates that moving a member to optimal adherence in these categories can save up to $1,900 a year in medical costs.

Formulary strategies enable the PBM to take advantage of market competition, effectively negotiate rebates, and promote the use of lower-cost clinically appropriate options. In 2018, clients and members saved due to our decision to exclude the high-cost long-acting insulins (LAIs) Lantus and Toujeo, and make Basaglar, a less expensive form of the same insulin, a preferred formulary product. Costs for a 30-day supply for members using Basaglar were 9 percent lower than costs for those using Lantus or Toujeo, and clients benefited from a 21.7 percent reduction in cost per LAI prescription.

In our commercial cohort, only 1 percent of claims were for specialty drugs in 2018, yet those claims accounted for 45 percent of costs, up from 42 percent in 2017. Plans that adopted two or more of our management programs were able to cut specialty trend substantially. Due to a robust pipeline and limited competition, specialty spend will continue to grow and requires a tight management approach.

Over three years, 2016-2018, PBM solutions saved clients more than $141 billion on pharmacy spend. We also estimate clients saved more than $18.3 billion in medical cost avoidance due to adherence improvements that resulted from lower member out-of-pocket costs and targeted interventions.