Since 2010, the allowed medical pharmacy amount has increased from 9 to 13 percent in the commercial marketplace, according to a report released today by Magellan RX Management.
The fifth annual medical pharmacy trend report, which analyzes high-cost injectable drugs paid for under medical benefits, also found that 81 percent of payors did not vary member cost share requirements by service sites in 2014; oncology-related medications represented 52 percent of medical pharmacy spending for commercial members and approximately 60 percent for Medicare members; and 49 percent of commercial expenditures were billed from hospital outpatient settings where reimbursements for drugs was two to three times the average sales price.
The report examined data gathered over the past four years, including recent survey responses from 48 individual health plans that collectively manage 125 million patients.
“This year’s report includes several enhancements that provide a more extensive view of the medical benefit drug landscape," Mostafa Kamal, senior vice president and general manager of Magellan Rx Management’s specialty drug division, said.
“We continue to see rising year-over-year trends in the medical pharmacy segment underscoring the critical importance of proven strategies and programs to help clients identify and manage this growing spend."