February 7, 2018
With the beginning of the new year, Pharmacy Benefit Managers (PBMs) are beginning to release 2017 data, along with forecasts for 2018. Express Scripts recently released their “2017 Drug Trend Report.” With this report, Express Scripts provides insight into the utilization trends and costs for 34.3 million members. Interestingly, despite the growth in cost and utilization of specialty drugs, the study found that nearly half of employer-based plans saw a slight decrease in per member cost! For those employers with high levels of specialty drug utilization, outcomes were much different. Because of specialty drugs, employer plans face a higher degree of uncertainty when setting pharmacy budgets.
Key findings of the study include:
1. Per person spending on prescription drugs rose 1.5% in 2017.
2. Spending on so-called traditional drugs declined by 4.3%, primarily due to a decrease in per unit costs.
3. Spending on specialty drugs increased 11.3% in 2017.
4. Because of increased controls on opioids, days supplied dispensed per person decreased by 10.3%. Advanced opioid management programs resulted in a 60% decline in days supplied.
5. Cost increases will be most pronounced in the following categories: Inflammatory conditions, oncology, HIV, and anticoagulants.
6. Gene therapy advances that cure previously untreatable conditions will require new approaches in delivery and financing.
A link to the study can be found here.
October 20, 2022
On October 18, 2022, the Internal Revenue Service (IRS) released Revenue Procedure 2022-38, which increases the health flexible spending account (FSA) salary reduction contribution limit to $3,050 for plan years beginning in 2023, an increase of $200 from 2022. Thus, for health FSAs with a carryover feature, the maximum carryover amount is $610 (20% of the $3,050 salary […]
August 14, 2018
The Affordable Care Act (ACA) requires insurers who plan on modifying plan premiums to submit their rates to either the state or federal government for review. This applies to plans included on state and federal healthcare insurance exchanges. The rate review process is designed to improve insurer accountability and transparency. It ensures experts are evaluating whether the proposed rate […]