Commercial Specialty Trend
Decreased unit cost helped total trend and kept growth to mid-single digits.
How Did Navitus Control Specialty Cost?
This was achieved through the disruptive cost-plus model of Lumicera Health Services, which anchors the specialty pharmacy network. Clients were billed only for the prescription cost, plus a management fee, eliminating significant price mark ups commonly seen in this marketplace.
People who use specialty medications need more than just a pharmacy. The Lumicera cost-plus model provides:
- Excellent, high-touch care
- Industry-leading client and patient savings
- Best-in-class patient satisfaction
To learn more, go to Lumicera.com
Lumicera's Centers of Excellence
Lumicera's three Centers of Excellence (CoE) provide:
• Specially trained clinicians with disease state expertise• Clinical programs specific to each patient's disease state
• Financial assistance to help patients better afford their medications
• Elevated patient care
Trend Drivers:
a look back
IMMUNOLOGY
Representing nearly half of the overall specialty spend, the targeted immunomodulators (TIMs) class of drugs continued to have a major trend impact on the overall commercial specialty trend. Spending remained flat because of rebate enhancements ahead of anticipated biosimilar launches.
These products are used to treat a wide variety of conditions including:
- Rheumatoid arthritis
- Crohn’s disease
- Ulcerative colitis
- Plaque psoriasis
- Atopic dermatitis
ONCOLOGY
The oncology category grew to 15% of overall commercial spend, despite being well managed with generics making up 30% of prescriptions. This increase was a result of:
- 12% increase in overall use
- 3% brand drug price inflation
The Value of Generics
On average, the cost of a generic oncology drug was less than $500 due to Lumicera’s cost-plus approach, compared to over $10,000 per prescription for a brand oncology agent.
MULTIPLE SCLEROSIS
Continued adoption of generic alternatives for multiple sclerosis medications drove significant cost savings for clients and members including:
- 7% decrease in overall spend
- 4% reduced utilization
- 3% decrease in unit cost
Plus, the generic dispensing rate was over 50% in this category. Generics drug costs averaged ~$700 per prescription versus $7000 per brand prescription.
DERMATOLOGY
This category saw an overall trend increase of 39% in 2022. This was caused by:
- 7% increase in brand name prices
- Limited generic alternatives
Pipeline:
a look ahead
BIOSIMILAR LAUNCHES
2023 will mark the launch of biosimilar products for two of the highest spend products on the market today: Humira® (adalimumab) and Stelara® (ustekinumab).
As of Q2 2023, Navitus has already added the lower list price version of the first adalimumab biosimilar, Amjevita™, as a preferred low-cost option on the formulary. Further changes are expected throughout 2023 as additional biosimilar products and the first ustekinumab biosimilar products are launched on the market.
Learn more about Navitus’ approach to ensuring that plans receive the full savings benefit from biosimilars.
NEW ULTRA-HIGH-COST TREATMENTS FOR RARE AND ORPHAN DISEASES
While less than 10% of Americans are impacted by a rare or orphan disease, the cost implications of these medications have a huge impact on spend.
- 39% of these medications cost more than $100,000 per year
- Multiple medications are expected to be approved in 2023 and 2024 that will likely cost $500,000 to $1,000,000 per year.
Discover how Navitus can help you mitigate the impact of ultra-high-cost drugs
NEW TREATMENTS FOR INFLAMMATORY SKIN CONDITIONS
Oral JAK inhibitors are a class of medications that have a growing role in new treatment options for inflammatory skin conditions including vitiligo and alopecia areata, which previously lacked effective treatment.
Oral JAK inhibitors have also recently been approved for the treatment of atopic dermatitis. This will be an effective, but more costly alternative to existing medications and will likely lead to an increase in costs in this drug category.
What's all the buzz about biosimilars?
