2019 Drug Trend Report

At 1.4 percent, overall trend in 2019 was the lowest in five years, despite increases in prescription utilization and ongoing manufacturer-driven price inflation. Trend for clients who opted for tighter management strategies was even lower and overall, 41 percent of our commercial clients had negative trend. Through smart formulary and utilization management strategies we mitigated the impact of price inflation, prioritized lower-cost and generic options when clinically appropriate, and delivered negative price growth for non-specialty drugs and very low price growth for specialty drugs. This enabled us to deliver low net trend and single-digit specialty trend for a broad cross-section of clients, covering more than 25 million commercially-insured lives.

Specialty treatments now comprise nearly half of all pharmacy spending and remain the key management challenge. New specialty drugs dominate the pipeline and, along with supplemental indications for existing products, spur utilization growth, which accounted for 80 percent of specialty trend in 2019. Despite these factors, with focused management, we helped our clients keep specialty trend in the single digits. Clients who opted for tighter management reduced trend even more.

Formulary and utilization management (UM) strategies remain the foundation of effective pharmacy benefit management. Our strategies enabled clients to ensure appropriate use and mitigate the impact of high-cost drugs that do not demonstrate a clear clinical benefit. In addition to negotiating discounts from manufacturers on behalf of our clients, we use industry-leading formulary strategies — including preferred placement and drug removals — to encourage use of lower-cost and clinically equivalent generic options when appropriate.

Cost can be a barrier to adherence and can force tough decisions about whether or not to fill a prescription. Keeping prescriptions affordable for plan members continues to be a key priority. We helped keep member costs low with formulary designs that prioritize lower-cost products, and solutions such as $0 copay preventive drug lists and point-of-sale rebates, which enables clients to pass on all or a portion of the rebates we negotiate from manufacturers to members during the deductible phase. Member costs declined year-over-year.