Five Forecasts and Takeaways for Plan Sponsors in 2023

As we enter 2023, David Fields is sharing his top forecasts and takeaways for plan sponsors and the PBM industry.

Prescription drug prices, accessibility and affordability continue to be a major topic of conversation as we enter 2023. Many Americans are considering how they will afford their medications with inflation and looming economic uncertainty. Similarly, plan sponsors are seeking new ways to reduce unnecessary health care costs in the face of recessionary fears and are anxious to see how the Inflation Reduction Act (IRA) will impact their pharmacy spend in the years to come.
 
Here are my top five forecast trends for the pharmacy benefits industry this year and thoughts on how plan sponsors can respond to reduce spend and improve the health of members.

#1 Biosimilars are poised to deliver significant cost savings

The future of biosimilars is exciting as they offer the potential to increase competition and lower costs for biologic therapies, the most expensive medicines in the world. According to the IQVIA Institute, biosimilars are projected to produce $104 billion in savings between 2020 and 2024, a huge jump from $19 billion in savings between 2015 and 2019.

Takeaway for 2023: The arrival of the first significant biosimilars will inform market, prescriber and plan sponsor actions. As more biosimilars become available in 2023, there is an opportunity to bring these high-quality, lower-cost treatment options to millions more patients. PBMs will engage manufacturers to manage spend during this time of explosive growth. Ask your PBM for their recommendations regarding assessing the landscape, performing net-cost comparisons, and adding biosimilars to your formulary.

#2 There will be an increased demand for access to affordable gene therapy options.

Gene therapy is expected to represent a significant portion of specialty growth in the next decade. Gene therapy treatments are created to treat, reverse, or cure a serious condition by modifying the expression of a patient’s genes or repairing abnormal genes. While promising therapies, these new treatments are incredibly expensive.

Takeaway for 2023: It is critical to partner with a PBM to manage your specialty pharmacy spend while enabling access to gene therapies. Work with your PBM to discuss reimbursement and risk management options that support members and ensure they are considered appropriate candidates for their potential treatment.

#3 New partnerships will play a key role in addressing pain points of the current drug supply chain, increasing access to lower-cost, generic-first channels.

This has been demonstrated through Navitus and Lumicera Health Services’ partnership with CivicaScript. CivicaScript launched its first generic drug, abiraterone acetate, which is used to treat prostate cancer that has spread to other parts of the body. This generic drug is available through Lumicera Health Services, a specialty pharmacy wholly owned by Navitus. CivicaScript has also announced plans to manufacture and distribute affordable insulin, which will help millions of people who often have to choose between life-sustaining medicines and other living expenses.

Takeaway for 2023: Working with a PBM partner that collaborates with others in the health care industry to expand medication affordability is equally important to finding a PBM that aligns with your needs and desired pharmacy benefit. Keep an eye on partnerships in the PBM industry and how your PBM partner is expanding their services and capabilities.

#4 The Inflation Reduction Act (IRA) will begin having implications for plan sponsors in 2023.

The IRA provides the Centers for Medicare and Medicaid (CMS) the ability to negotiate Medicare Part D prices for high-cost drugs. While the program for lowering drug costs won’t begin until 2026, there are three provisions going into effect in 2023. The first is that insulin copays will be limited to $35 per month for people with Medicare. Secondly, cost sharing for adult vaccines covered under Medicare Part D will be eliminated. Lastly, drug manufacturers that increase prices faster than the rate of inflation will be required to pay rebates beginning in 2023. These rebates are in place with the expectation that the growth of medication prices will reduce over time.

Takeaway for 2023: This bill makes notable strides toward improving the affordability and accessibility of health care by creating downward pressure on drug prices and lowering out-of-pocket costs for Medicare beneficiaries. The number of Medicare beneficiaries who will see reduced costs each year varies according to a number of factors. Reach out to your PBM partner to learn more about how your plan and beneficiaries might be impacted.

#5 We will see increased impact of real-time data and analytics.

As technology continually advances, PBMs will take advantage of machine learning (ML) and artificial intelligence (AI) capabilities to bolster drug assessments and reviews to expedite support and care for utilizing members. Continued industry efforts to further interoperability and integration are critical for sharing helpful information across the care continuum. 

Takeaway for 2023: Assess your PBM’s arsenal of data and analytics tools to optimize opportunities for improved care and plan performance. However, keep in mind, not all PBM contracts give you access to view and audit documents, data, network pharmacy arrangements, pharmaceutical manufacturer contracts and claims data. Only a truly transparent PBM allows access and authorization to use all your plan’s data at any time.

what to expect from navitus in 2023

At Navitus, during these times of uncertainty, we go back to our mission: make medications more affordable for the people who need them, so they can live their lives more fully. We have been purpose-driven since we opened for business in 2003, and we have stayed the course all these years.