In 2020, specialty trend — which consists of utilization and cost trend components — continued to increase, but it did so at a slower pace than that of the past five years. That’s one of the findings of Pharmaceutical Strategies Group (PSG), an EPIC company, in its State of Specialty: Spend and Trend Report, published in August. The report, which is based on PSG’s Artemetrx platform and uses integrated pharmacy and medical claims data, also found that biosimilars finally are beginning to produce real savings.
Artemetrx analyzed 62.1 million medical claims and 50.4 million pharmacy claims from its book of business for the report. From 2018 to 2019, the specialty trend was 14.8%, while from 2019 to 2020, it was 11.8%. Most of the percentage was driven by claims utilization, at 9.0%, with cost per claim responsible for the remainder. The per-member per-year trend in the pharmacy benefit increased 17.3% compared with a PMPY trend in the medical benefit of 3.7%. Within the latter benefit, home infusion PMPY trend rose 8.8%, followed by outpatient hospital at 4.0% and physician office at 1.7%.