Medco predicts in its 2010 Drug Trend Report that over the next three years, medications in 6 of 16 broad categories will account for about 72 percent of drug cost and utilization.

Leading the way will be agents in the central nervous system and endocrine and diabetes categories, which when combined will account for 40 percent of the spending growth.

Of interest is the cardiovascular category. Compared to last year’s report, the current report suggests that the cardiovascular drugs’ category will see a significant change in share of drug spending and drug costs.

The report says that this category will amount to a large share of total drug costs this year but it will be a less significant contributor to drug costs over the next three years — just 7 percent of total projected drug costs.

That’s because Medco expects a greater effect of generic drugs in the cardiovascular class — in particular the report cites the patent expiration of Lipitor and arrival of several new generics in the angiotensin II receptor blocking class.

Generic drugs have helped moderate the growth of spending on cardiovascular drugs in the past. For example, lipid-lowering drugs had a drug cost of 0.9 percent last year, compared to the total drug cost. When generic versions of Pravachol and Zocor became available in 2006, costs for cardiovascular agents dropped the following two years — 8.5 percent in 2007 and 3.4 percent in 2008.

In 2007’s report, cardiovascular agents were expected to contribute about 24 percent of overall pharmacy spending growth between 2007 and 2009.

The current predictions are based on utilization and cost data collected from 2007–2009 for employers with integrated retail and mail-order benefits.

The average monthly enrollment in the data sample was over 40 million members. This year’s projections include members who enrolled in Medicare Part D plans.

Top therapeutic categories contributing to drug costs (2010–2012)

Source: Medco. 2010 Drug Trend Report — Solving the Healthcare Cost/Quality Equation

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.