Non-Specialty Commercial Trend
The negative cost trend was a result of a reduction in unit cost that offset modest utilization growth. Costs well-managed with improved pharmacy network contracting and enhanced rebates on high-cost medications.
Trend Drivers:
a look back
DIABETES
Diabetes costs decreased 3% because of:
• 9% decrease in unit cost
• 6% growth in utilization
Insulin costs decreased 20%, with increased competition from biosimilars and authorized generics. Growth was concentrated on treatments for type 2 diabetes. The use of incretin mimetic agents, also know as GLP-1 receptor agents, increased 40% because of new prescribing guidelines and off-label use for weight loss.
Navitus Actions: In Q4 2022, Navitus implemented a point of service check to support cost containment and appropriate prescribing.
ANTIVIRALS
Overall commercial cost trend for antivirals was flat in 2022. The category includes treatment for a wide variety of viral infections including influenza, herpes and HIV.
Despite an 8% increase in utilization, driven by influenza and HIV treatment, cost was controlled by increased rebates on HIV products.
Attention Deficit Hyper Activity Disorder (ADHD)
The trend included:
• 10% increase in utilization that reflected national trends for use of ADHD products in adults
• Flat unit cost as use of generics continued to rise
Pipeline:
a look ahead
Generic launches
In 2023 and 2024, projected generic launches in the non-specialty space are expected to have minimal impact on overall trend.
Major Depressive Disorders
Savings are already being seen from the launch of lurasidone (brand Latuda®), for the treatment of schizophrenia, bipolar and major depressive disorder earlier this year. Multiple generic versions are now available.
What is the Impact of New Generic Drugs?
The newly launched generic lurasidone saves over $1000 per 30-day prescription compared to the brand product.
ADHD
In late 2023, lisdexamfetamine, the generic version of Vyvanse®, is expected to be released. As the brand drug represents over half the spend in the ADHD category today, it will likely lead to significant savings in 2024 and beyond.
chronic weight management
New therapeutic breakthroughs, growing clinical acceptance of treatments and omnipresent consumer marketing campaigns are applying growing pressure to the chronic weight management marketplace. Demand is likely to increase significantly. With increased use and high drug costs, these medications have the potential to increase costs by 20-50% with even modest adoption.
How can plans contain these costs?
- Point of sale check that requires an approved diagnosis code
- Step therapy to require use of a lower cost medication before GLP-1s are approved
- Combine weight loss medication with the use of behavioral, exercise wellness program
- Balance the cost of these medications against the potentially greater cost of obesity complications
These products are being shown to be clinically effective for weight loss. However the cost, at over $10,000 per patient per year, has the potential to increase plan costs by 20-50% with even moderate adoption.
insulin
Navitus is committed to lowering the cost of this life-saving medication for its members. As part of their mission, they have:
- Placed biosimilars and authorized generic products on their formulary
- Joined CivicaScript to further the availability of lower-cost generic medications
- CivicaScript is developing generic insulins that are likely to be launched in late 2024
In early 2023, key brand insulin manufacturers announced massive price cuts on select list prices in 2024. The impact for Navitus clients will be minimal, as Navitus has already passed along rebates that are at or above the percentage of these brand price cuts.
respiratory syncytial virus (rsv) vaccines
Each year between 120,000 - 240,000 people are hospitalized because of RSV.1 While RSV typically has mild cold-like symptoms, it can also cause serious illness, particularly in children and older adults.
Two vaccines, Abrysvo™ and Arexvy® have recently been approved to prevent severe complications in adults over 60. Abrysvo may also get approval for pregnant women to provide protection for infants.
1 www.cdc.gov/rsv/research/index.html
