In the 2020 Drug Trend Report recently released by Evernorth (see infographic, p. 3), the Cigna Corp. division added yet another chapter to the growing volume of data detailing the profound effects that the COVID-19 pandemic has had on health care.
On the one hand, the massive amount of deferred routine and elective health care utilization had a dampening effect on the number of new medication users that Evernorth — which houses the PBM Express Scripts — recorded in 2020. New users of asthma/COPD medications dropped the most, by 7.1% year over year, likely reflecting the avoidance of clinical settings among a group that is at particular risk of contracting severe COVID-19.
Yet for commercial plans managed by Evernorth, the overall drug utilization trend increased by 3.1%, compared with just 1.4% in 2019.
“We saw higher utilization of prescription drugs to treat mental health issues associated with the pandemic — anxiety, insomnia, and depression,” says Evernorth Chief Innovation Officer Glen Stettin, M.D. “Among people with previously diagnosed and common chronic conditions, such as diabetes, high blood pressure and heart disease, many of which are risk factors for hospitalization and death from COVID-19, we also saw an increase in utilization. This utilization was driven by higher medication adherence, itself a result of more people choosing to fill their medication for 90 day vs. 30 day supplies, and the convenience and safety of having their medication delivered to their homes.”
The overall use of diabetes drugs, for example, increased by 7.4%, while utilization of asthma/COPD medications and anticoagulants each ticked up by 6.6%. To respond to the rising demand, Evernorth said it ordered significantly more albuterol.
Similarly, “when we saw spikes in prescriptions for treating COVID-19 inappropriately with hydroxychloroquine, we worked to protect the supply for people who truly needed it to treat rheumatoid arthritis and lupus,” the report said.
Evernorth’s report also included statistics that are typical of drug trend reports in more normal years. The Cigna division reported 4% total trend across its commercial plans, 3% trend in Medicare, 1.4% in Medicaid and 5.5% in health insurance exchange plans.
“Adverse selection likely played a small part in driving higher trend for health exchange plans,” the report suggested. “Of the top five classes, four are driven primarily by specialty medications, and the difference in prevalence rates among these classes compared to commercial plans is very small.”