More than 400 nationally-recognized payers, physicians, and industry insiders came together to share thoughts and insights on the ever-evolving specialty drug landscape at the 16^th annual 2019 Magellan Rx Management Specialty Summit hosted August 26-28 in New York City.

As the specialty drug trend continues to rise (especially on the medical benefit) and the pipeline continues to expand, focusing on management strategies and solutions is key. With biosimilars flooding the market and capturing the headlines, and looming policy updates creating uncertainty, this year’s event was a platform to tackle these critical topics and the future of our industry.

“We’re honored to be the forum that brings people together to share insights, engage in thoughtful debate, so that we can all walk away with actionable solutions to effectively manage this growing specialty drug trend.” –Steve Cutts, senior vice president & general manager, specialty, Magellan Rx Management

Highlights from this year’s program include:

• Dr. Peter Bach of the Memorial Sloan Kettering Cancer Center reviewed the latest developments for better oncology management and Dr. Rafael Fonseca, a Mayo Clinic Distinguished Investigator, examined applications for a more personalized approach to treatment for complex specialty conditions.
• Magellan Rx chief medical officer Dr. Caroline Carney was joined by Sarah K. Emond, executive vice president and chief operating officer of the Institute for Clinical and Economic Review (ICER), in a fireside chat about ICER’s approach to health policy and excellence in the U.S.
• Mostafa Kamal, CEO of Magellan Rx, led a panel of forward-thinking innovators who are disrupting the status quo by providing tech-based solutions to improve healthcare delivery and outcomes: Raj Agarwal, chief executive officer at Medocity; Adam Hanina, chief executive officer at AiCure; and Richard Waithe, president of VUCA Health.
• Several panel discussions highlighted next-level management strategies around medical pharmacy solutions as well as emerging therapies like CAR-T and other gene therapies to treat rare and orphan diseases, and featured a diverse group of speakers including executives from national and regional payers, pharmaceutical manufacturers, and physicians:
  • Martin Burruano, RPh, Vice President, Pharmacy Services, Independent Health
  • Mona Chitre, PharmD, CGP, Chief Pharmacy Officer & Vice President Clinical Analytics, Strategy & Innovation, Excellus BlueCross BlueShield
  • Kim Dornbrook-Lavender, PharmD, BCPS, Director, Clinical Pharmacy, Medica
  • Pat Gill, RPh, Director of Pharmacy Programs, Horizon BCBCS of NJ
  • Doug Long, Vice President, Industry Relations, IQVIA
  • Joseph Nolan, General Manager – US, AveXis, Inc.
  • Helio Pedro, MD, Clinical Geneticist, Hackensack Meridian Health
  • Carly Rodriguez, PharmD, Pharmacy Director, Clinical Innovation, Moda Health
  • Natalie Tate, PharmD, MBA, BCPS, Vice President, Pharmacy Management, BlueCross BlueShield Tennessee
• Industry experts Claire Wulf Winiarek, Beth Hebert-Silvia (VP & Practice Lead, Health Plans at Pharmaceutical Strategies Group) and Michael McCaughan (founding member of Prevision Policy LLC) shared their insights on the current policy landscape.
• TV personality and author Janice Dean graced the audience with her very own patient story—after receiving a Multiple Sclerosis diagnosis in 2005, she underwent treatment and found hope and a passion for sharing her story to encourage others who are living with MS to live their best lives as well.
• Keynote speaker Keller Rinaudo shared his incredible story of perseverance that led to the launch of a revolutionary healthcare startup, Zipline, that is rapidly changing the face of medicine in remote parts of the world—and future expansion for U.S. disruption.

As pioneers in specialty pharmacy management since 2005, Magellan Rx has been leading the conversation around better management strategies that not only provide cost savings for payers but positively impact patient health outcomes. Each year, we develop the Specialty Summit agenda with those values in mind. Mark your calendars and join us next year in NYC on August 24-26, 2020 as we host another event that will ignite inspiration and innovation across the industry.

Understanding pharmacy trend is important for developing robust, cost-saving specialty drug management strategies. But did you know you can’t really compare one trend number to another? Every PBM uses different methodologies, data sets, and calculations to arrive at their pharmacy trend number.

Additionally, one of the largest cost drivers of specialty spend today—prescriptions drugs dispensed through the medical benefit—is typically missing from pharmacy trend statistics. When you combine pharmacy benefit with medical benefit spend, you get what we like to call big ‘T’ Trend. In fact, you need to combine both to see there is as much, if not more, specialty spend going through the medical benefit today that is going unmanaged.

The ninth edition of the Magellan Rx Management Medical Pharmacy Trend Report includes a comprehensive medical pharmacy trend analysis and data benchmarking for provider-administered drugs which are infused or injected and paid under the medical benefit.

What are the top medical pharmacy trends you need to know to stay current with your organization’s management strategies?

1. Per-member-per-month (PMPM) spend on provider-administered drugs increased by 18% for commercial members in one year, reaching nearly $30 PMPM. The five-year trend is 68% — the highest jump in 9 years of reporting.
2. Across all lines of business (LOB), more than 90% of total drug spend on the medical benefit is being driven by a fraction of members who are taking specialty medications.
   
3. Emerging oncology treatments, particularly immunotherapy, are a major medical pharmacy trend driver. Keytruda had an impactful increase in utilization, with PMPM trend rising upwards of 200% and breaking into the top 15 drugs across all LOBs.
4. In Medicare, oncology and oncology-support drugs accounted for 58% ($30.17) of the medical benefit drug PMPM spend.
5. Chimeric antigen receptor (CAR) T cell gene therapies are predicted to grow 530% by the year 2022.
6. Factor products to treat hemophilia demonstrated the highest trend in both commercial (62%) and Medicare (185%), ranking #5 and #6, respectively. The average cost per claim is close to $20,000 across both LOBs.
7. Although 68% of payers are now using a site of service (SOS) program, SOS continues to be a concern with drugs administered in the hospital outpatient setting continuing to cost 2-3 times more than physician offices and home infusion.
8. When it comes to biosimilars, 64% of payers stated that the price of the biosimilar most impacted reimbursement decisions.
9. The top five drugs in commercial (Remicade, Neulasta, Rituxan, Herceptin, and Avastin) have remained consistent over the last nine years of reporting. However, all of these drugs have FDA-approved biosimilars that should all be available on the market in the next few months and, looking ahead, this landscape may look different over the next few years with this increased competition.
10. The number of billion-dollar drugs in 2017 was 34 and is projected to grow 26% to 43 drugs by 2022. All 43 are currently available on the market today, representing increased utilization and growth of these products in the next five years and reinforcing the need for proper utilization management, targeted dosing optimization and other management tactics of these high cost medical specialty drugs which will help to promote quality of care and prudent savings of healthcare dollars.

For more in-depth analysis on the latest in medical pharmacy trend and spend, watch our on-demand webinar!