October 19, 2023
Pharmacy trends increased in 2022 and specialty drugs remain the primary cost trend driver. However, Premera data shows pharmacy trends gradually decreasing; we’re excited to see that we are indeed bending the cost curve.
Our existing programs such as Utilization Management, RationalMed, and Channel Optimization for Specialty drugs have proven to be a success. We are implementing new programs such as Right Price, Rx Savings Solutions, Specialty Split Fill, and modular formulary options that will continue to save our members money and reduce pharmacy spend.
Weight loss drugs
Demand continues to rise for GLP-1 weight loss drugs like Wegovy. Premera is dedicated to evaluating our prior authorization approach and clinical documentation requirements to ensure we’re managing this class of drugs ahead of industry standards, including clinical evidence supporting utilization of the drugs for the appropriate conditions. Effective weight loss for many Premera members will be a combination of prescription weight loss drugs and lifestyle changes to optimize treatment.
Biosimilars
The biosimilar market in the U.S. is projected to grow from less than $10B in 2022 to more than $100B by 2029. Our approach to biosimilars is to make thoughtful decisions that ensure long-term success. In the case of complex inflammatory conditions, we’re focused on providing options and access to ensure a clinically responsible approach for our members. As more biosimilars come to market, we anticipate that the increased biosimilar competition will drive down costs, presenting cost management opportunities over time.
Premera continuously monitors biosimilar releases so we can update our preferred products and will re-evaluate our strategy to ensure that we are directing members to the most clinically appropriate, and most cost effective, biosimilar product available. Premera has a proven track record of accelerating biosimilar use to drive meaningful cost savings; we successfully converted 99% of brand utilization to biosimilars for cancer treatment support drugs.*
*Source: Pharmacy Analysis Reviewed by HCE; Commercial Groups Excluding FEP, NASCO, Medicare Advantage, and Medicare Supplemental; *GCSF (granulocyte colony-stimulating factor) drugs; Details: If Premera paid the 2019 average allowed cost per unit in medical drug categories with a biosimilar in 1Q 2022-3Q 2022, we would have paid $22M more. Annualized for CY22, we would have paid $29M more. The average allowed cost per unit in medical drug categories with a biosimilar decreased by 54% from 2019 to 1Q 2022-3Q 2022.