Prime Therapeutics delivers single-digit pharmacy trend increases for Commercial and Medicare Part D despite increased medication use

Commercial drug trend held to 4.7% while Medicare Part D trend is nearly flat at 0.1%

March 11, 2020

EAGAN, Minn. – Today, Prime Therapeutics LLC (Prime), a pharmacy benefit manager (PBM) serving more than 30 million members nationally, reported its annual pharmacy drug trend for 2019 as 4.7% in its commercial book of business and 0.1% across Medicare Part D. Medicaid trend was 10.2%.¹ Prime also delivered $3.3 billion in savings for its 23 health plan clients last year across all market segments.²

The most powerful driver of trend across all books of business was an increase in drug utilization – especially among specialty drugs: 10.0% for commercial; 15.5% for Medicare Part D; and 20.1% for Medicaid. Cancer (oral) and autoimmune drug categories were the highest drivers of specialty trend due to new indications for existing drugs.

A key area that mitigated overall trend from climbing higher included a decrease in utilization and trend in the pain category. In Prime’s commercial populations, pain trend decreased -11% and utilization decreased -5%. Medicare also saw reductions with -19% trend and -8% utilization. In the government program segments, brand drugs transitioning to generics contributed to negative net unit cost trends which helped control overall trend. For commercial and Medicare, Prime’s inflation protection within manufacturer contracts allowed unit cost trend to stay low despite price increases.

In 2019, more than half of the 48 new drugs approved by the Food and Drug Administration (FDA) were specialty drugs. Given the high cost of specialty drugs in the pipeline, they are likely to continue to drive trend in 2020 and beyond, especially among the oncology, autoimmune and gene therapy categories.

Prime’s $3.3 billion in savings included both incremental and total year savings and cost avoidance from several programs: fraud, waste and abuse activities; network contracting; rebate improvements; and formulary strategies.

“Year-over-year, Prime has helped put its health plan clients in the best possible position to offer affordable pharmacy benefit solutions to its members. With some drugs now reaching six-figure prices or more, we are working closely with our clients and deploying innovative solutions to help them manage members’ total cost of care on both the pharmacy and medical benefits,” said David Lassen, PharmD, chief clinical officer at Prime. “With innovative agreements in place that deliver steeper savings through configurable solutions, data-driven analytics and a keen member focus, Prime is well-positioned to achieve even more positive outcomes in the new decade.”

  1. State Medicaid regulations continued to broaden formularies and allowed for less ability to implement management tools. Due to these constraints, Medicaid trend is not reflective of Prime’s management capabilities.
  2. Based on internal Prime analysis.
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