Navitus Drug Trend Report: Keeping Costs Low for Plans and Members in an Era of Accelerating Inflation

Business Wire

a day ago

MADISON, Wis.--(BUSINESS WIRE)-- Navitus, the nation's first transparent, pass-through pharmacy benefit manager (PBM), released its ninth annual Drug Trend Report today, revealing how commercial plan sponsors saved millions in prescription costs while maintaining high-quality member care. 30% of Navitus clients spent less in 2024 than in the previous year, while overall client book of business drug cost trend was managed to 7%. The data shows that medications such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are creating unprecedented financial pressure on plan sponsors as utilization for diabetes treatment increased 26% year-over-year.
Overall health spending in the United States is nearly $4.9 trillion and projected to increase nearly 6% annually over the next decade. 1 A subset of this, prescription drug spending, was estimated to be $487 billion in 2024, an industry-wide 11.4% increase over the previous year, compared to 7% for Navitus clients. While the industry faces these escalating cost pressures, our latest Drug Trend Report highlights how Navitus continues to outperform industry trends and save clients money in this challenging environment, including companies such as Progressive Insurance.
'Navitus stands out for its commitment to transparency and managing to lowest net cost, which has significantly benefited Progressive and its members. From the outset, their 100% pass-through model has ensured that we receive the full value of manufacturer rebates and discounts, directly translating to reduced pharmacy costs,' said Heidi Minter, Data Analyst, Benefits & Design Services, Progressive Insurance.
The Navitus Drug Trend Report revealed three critical trends influencing the broader industry:
1.
26% increase in GLP-1 RAs use for treatment of type 2 diabetes. While delivering significant clinical benefits, these medications are contributing substantially to pharmaceutical cost increases for benefit plans:
Net trend in the diabetes category increased 8.5%, driven by growth in both the use of GLP-1 RAs, including Ozempic, Mounjaro and Trulicity, and a 16% increase in use of sodium-glucose cotransporter-2 inhibitors (SGLT-2s), including Farxiga and Jardiance.
The prevalence and cost of GLP-1 RAs and SLGT-2s resulted in an overall unit cost increase of 3.0% for the diabetes category, in spite of the net cost decrease of more than 28% for insulin in 2024.
2.
Biosimilars delivered $315 million in savings with a 60% reduction in Humira costs. Targeted immunomodulators (TIMs) treat a wide range of autoimmune disorders, from rheumatoid arthritis and psoriasis to inflammatory bowel diseases. The launch of Humira biosimilar alternatives in 2023 significantly changed the landscape of the category as these clinically-equivalent, much lower cost options were added to formulary. After adding biosimilars to formulary, Navitus took a decisive step to lower costs further by removing Humira from formulary in June 2024. This led to key results including:
Over $315 million in upfront cost savings.
60% reduction in net costs per claim.
3.
Specialty medication utilization increased 12%. Approximately 75% of new drug approvals have been for specialty or medical specialty agents, and that trend is expected to continue in the next two years. Key factors included:
Oncology net trend increased more than 13%, driven by both higher utilization and unit cost: Utilization of newer breast cancer treatments (Kisqali, Verzenio) increased 20%, driving overall cost.
In specialty dermatology, Dupixent (dupilumab) emerged as the most rapidly growing drug of 2024. The category saw a net trend increase of more than 45% and Dupixent represented 96% of category cost and utilization.
While increased use of newer, more expensive agents like Kesimpta created upward pressure within the multiple sclerosis category, generics represented more than 50% of prescriptions filled at 10% of the cost.
Expand
'Our annual Drug Trend Report confirms we were able to control year-over-year costs for commercial clients - both large and small - and deliver savings greater than the estimated industry averages,' said Sharon Faust, PharmD, MBA, CSP, Chief Pharmacy Officer, Navitus Health Solutions. 'Deploying generic-first strategies, facilitating adoption of new biosimilars, ensuring 100% pass-through of negotiated rebates and discounts, and supporting clinically appropriate prescribing, utilization and formulary management remain core to our focus.'
Access the Navitus Drug Trend Report executive summary here: www.navitus.com/DTR2024
Methodology: The Navitus drug trend is calculated by comparing the net total cost per-member per-month (PMPM) for 2024 to that for 2023. Net cost PMPM represents full-year (Q1-Q4) data for total member copays and plan paid amounts minus manufacturer rebates and fees. This value is divided by the total number of members and by 12 months of the year. The data represents employer plan sponsors and health plans. In order to be included organizations must have been with Navitus for two full calendar years.
* Due to varying coverage decisions by clients, GLP-1s for weight loss were not included in the Drug Trend Report, yet they still warrant thoughtful consideration and conversation in the overall picture of trend and future decisions. The DTR only represents prescriptions under the pharmacy benefit. 40% of Rx spend is through the medical benefit and warrants careful consideration by plans.
Sources:
About Navitus
Navitus remains the nation's first transparent, pass-through pharmacy benefit manager (PBM). It uniquely brings clarity to drug pricing and takes costs out of the drug supply chain. Unlike traditional PBMs that generate profit by retaining an undisclosed portion of rebates and discounts negotiated with drug manufacturers and pharmacies, Navitus passes along the complete savings to clients, enabling them to make medication more affordable for their members. Navitus was established more than 20 years ago by Navitus Health Solutions, LLC, a pioneering pharmacy solutions company. The organization delivers a range of services through portfolio brands including Navitus, Lumicera, Archimedes. Owned by SSM Health and Costco, Navitus Health Solutions serves over 18 million lives across 800 clients including employers, unions, government plans, payors and health systems. For more information, please visit www.navitus.com.