Commercial
Non-Specialty Trend
In 2023 we saw utilization increases across much of the non-specialty category. While several factors contributed to higher non-specialty growth, none of them made the impact that glucagon-like peptide 1s (GLP-1s) did.
As health plans, sponsors and consultants navigate the landscape of the non-specialty drug trend, access to clear, concise data as provided in this report is essential to inform their decision making. For a more in-depth analysis, download the Executive Summary.
$49.80
Net Total Non-Specialty Cost Per Member Per Month (PMPM) for Commercial Clients in 2023
Diabetes
Unit cost increases across the diabetes category were directly tied to utilization growth in more expensive brand products, including glucagon-like peptide 1s (GLP-1s) and sodium-glucose cotransporter-2 (SGLT2) inhibitors used to treat type 2 diabetes. In 2023, utilization of these products increased by 30% and 20% respectively, resulting in a year-over-year cost trend of 15% within the category.
Within these marketplace dynamics, and to help clients control use to approved diabetes indication, Navitus implemented a pharmacy point-of-service diagnosis check. Those clients who implemented the point-of-sale utilization management control mitigated 30% of prescription fills by preventing those without an appropriate diagnosis.
Despite limiting off-label use, diabetic GLP-1 medications were the biggest contributor to trend growth in 2023. This single class of medication increased the total trend by 1.7%. As these products continue to gain favor as an early treatment for the ongoing treatment of type 2 diabetes, we expect to see these medications play a significant role in driving future trend.
Mental Health
More than one in five members used a medication for mental health in 2023.
Of note, a generic launched for Latuda® (lurasidone), indicated for the treatment of schizophrenia and bipolar disorder. Utilization of the generic was strong, achieving a 95% generic dispensing rate and driving down cost by 25% for the category.
Vyvanse® (lisdexamfetamine), prescribed for treatment of attention-deficit/hyperactivity disorder (ADHD), was the most utilized brand in its class. Even though a generic became available, drug shortages reduced competition across the category and limited price reductions.
Vaccines
Overall, there was a 2% decrease in vaccine utilization in 2023. However, costs increased because of expensive new vaccines coming to market, including for respiratory syncytial virus (RSV).
Medical Devices
The medical device category includes products such as continuous glucose monitors (CGMs) and wearable insulin pumps for patients with diabetes. CGMs are costly and may exceed $1000 per month. Usage of these devices grew by 50% in 2023, which contributed to increased spend in the category by 40% over the previous year.
