Why You Need a PBM During the Pandemic | Evernorth

Why You Need a PBM During the Pandemic

Three ways we achieved manageable drug spending growth in 2020, despite pressures from COVID-19
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When it comes to cholesterol levels, patients aim to appropriately increase their HDL (good cholesterol) and decrease their LDL (bad cholesterol). We take a similar aim with the two components of drug trend: appropriately manage utilization and decrease medication costs to deliver clinical and financial value for clients and patients.

For 25 years, our Drug Trend Report has delivered the data and insights payers need to provide high-quality care to their members while managing drug costs. In a year defined by COVID-19 that challenged health care like never before, the 2020 Drug Trend Report continues that tradition.

1.  Increase drug utilization for better health outcomes

Last year, drug trend for commercial plans increased by 4%, driven primarily by a 3.1% rise in drug utilization.

Higher utilization shows that patients with chronic conditions – including diabetes, heart disease, asthma and depression – were able to maximize their health by taking advantage of technology and safe delivery options, such has home delivery, to get the medication they needed. Better adherence to medication results in fewer downstream medical events such as hospitalizations, which is even more critical during the COVID-19 pandemic to keep hospital capacity as low as possible.

2.  Manage drug unit cost to protect payers’ and patients’ health care spending

In 2020, less than 1% of drug trend was due to unit cost.

While list prices for brand drugs continue to rise, our negotiating power and innovative solutions held unit cost increases to just 0.9% – and nearly one-third of commercial plans experienced a decrease in drug spending. The average out-of-pocket cost for patients for a 30-day prescription increased by just 85 cents.

During a year that dramatically changed the health care landscape, every dollar counts.

3.  Provide better care and savings through clinical solutions

Last year, spending on specialty drugs exceeded 50% of total drug spend for the first time. This was largely due to the introduction of costly treatments for conditions with no real competition. We moved to mitigate specialty costs in 2020 and beyond with a number of strategies, including formulary management and solutions for affording gene therapies and making fertility treatment more accessible.

Plans that took advantage of at least one SafeGuardRx® value-based care program decreased their drug trend by 3.4%. We saw better care and lower spending than nonparticipating plans across nearly every therapy class covered by SafeGuardRx, including Neurological Care ValueSM, which launched last year for conditions like migraines and epilepsy and is expanding to additional neurological conditions.

Even more significant: Plans that leveraged at least three of our solutions decreased trend by 9.2%. This is the power of the PBM. In total, our clinical solutions saved patients and plans $44.8 billion last year.

For these and other data insights, view the full Drug Trend Report.


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