PBMI Highlights the 2019 Trends in Specialty Drug Benefits

On the final day of PBMI’s 2019 National Conference, Jane Lutz, executive director of PBMI, Sharon Frazee, PhD, MPH, vice president of research and education of PBMI, and Rick Gates, senior vice president, pharmacy and health care, Walgreens, shared findings from the PBMI 2019 Trends in Specialty Drug Benefits report. 

According to the report, “Specialty drug spend is now 50% of total health care spend and this is expected to trend up in the years ahead,” said Ms Lutz. “With new specialty drugs entering the market, employers will need more in-depth reporting to help make informed decisions about their benefit plans.”

The report explained that medical benefit reporting still has a “50% gap with only half of respondents stating that their pharmacy benefit manager (PBM) or health plan tracks specialty and nonspecialty drug spend for drugs under the medical benefit.” 

“This report is an important tool to monitor trends and identify barriers to reducing costs. One strategy that has become crucial to addressing these barriers is working with partners to develop new solutions for patients, providers and plan sponsors,” said Mr Gates. “Walgreens’ collaboration with Prime Therapeutics and AllianceRx Walgreens Prime enables us to bring together pharmacy benefit management, health plans, and the pharmacy to deliver innovative
solutions that increase engagement and adherence, while improving outcomes and lowering costs.”

Other findings in the report included that 67% of respondents can track total health care outcomes and 63% can track adherence and persistency. On the other side, just 27% of respondents reported being able to track clinical efficacy and only 9% are able to track the impact of medications on employee productivity. 

The report also included data on calcitonin-gene-related peptides (CGRPs), the first biologic medications developed for migraine treatment. Having only been approved by the FDA last year, “Most respondents reported that their plan covers traditional preventive and acute treatment for migraines, however only 22% of employers cover CGRPs because they are either unaware of these medications or need more outcomes.”

Copies of PBMI’s full 2019 Trends in Specialty Drug Benefits Report can be requested from its website (www.pbmi.com). —Edan Stanley