Latest news with #Navitus
Business Wire
2 days ago
- Business
- Business Wire
Navitus Drug Trend Report: Keeping Costs Low for Plans and Members in an Era of Accelerating Inflation
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: 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
Yahoo
2 days ago
- Business
- Yahoo
Third federal lawsuit challenges Arkansas' restrictions on pharmacy benefit managers
A woman shops at a Walmart pharmacy in Illinois. () A third federal lawsuit, filed Monday, challenges Arkansas' first-in-the-nation law restricting the activity of pharmacy benefit managers in the state, arguing that it limits both a competitive pharmacy market and patients' access to prescription drugs. Pharmacy benefit managers (PBMs) negotiate prescription benefits among drug manufacturers, distributors, pharmacies and health insurance providers, and the biggest ones also own pharmacies and insurers. Navitus Health Solutions, one of the plaintiffs in Monday's lawsuit, urged lawmakers in April not to pass the bill that became Act 624 of 2025. The law bans pharmacy benefit managers from holding a permit to operate a drug store in Arkansas after Jan. 1, 2026. In Monday's complaint, Navitus and the Pharmaceutical Care Management Association (PCMA) allege that Act 624 will unfairly prevent out-of-state companies from doing business in Arkansas in the name of keeping local independent pharmacies afloat. 'Not only does Act 624 set out to protect local businesses from competition by out-of-state businesses, but it also aims to punish a discrete population of companies for perceived misconduct,' the complaint states. The Arkansas Insurance Department received thousands of complaints in 2024, claiming PBMs either illegally paid them below, at or just above the national average of what drugstores pay wholesalers for drugs, independent pharmacists and the department's general counsel told lawmakers last year. Arkansas governor signs first-in-the-nation ban on drug middlemen owning pharmacies Act 900 of 2015 required pharmacy benefit managers to pay pharmacies this average price at minimum, and the U.S. Supreme Court reviewed and upheld the law in 2020 after PCMA challenged it. Lawmakers and the Arkansas Pharmacists Association have claimed PBMs also routinely violate two 2018 laws that prohibit them from reimbursing their affiliated pharmacies in Arkansas at a higher rate than their locally owned competitors. The plaintiffs in Monday's lawsuit claim this allegation is false. 'Arkansas has never formally alleged in any judicial proceeding that PCMA's members or Navitus has violated these laws, and such allegations would not hold up in court if ever it did,' the complaint states. The Federal Trade Commission released an interim report in July 2024 saying PBMs are eliminating competition and increasing drug prices at the expense of patients. The report also states that three pharmacy benefit managers — OptumRx, Express Scripts and CVS Caremark — manage 79% of prescription drug insurance claims for approximately 270 million people. Lawmakers of both political parties frequently cited the FTC report when expressing support for Act 624. CVS Pharmacy Inc., Caremark's parent company, and Express Scripts each challenged Act 624 in federal court on May 29. Similarly to Monday's lawsuit, the other two argue that the law violates the U.S. Constitution by interfering with interstate commerce. The three complaints also allege that federal law preempts state laws that affect employee health plans and Medicare coverage. All three suits take issue with Act 624's exemption of the state's largest employer, Walmart, from the ban on PBMs owning pharmacy permits. They also claim Arkansans will lose access to mail-order and specialty pharmacy services, which are the only means of obtaining specific drugs. The lawsuits all ask the U.S. District Court of the Eastern District of Arkansas to bar enforcement of the law as well as declare it unconstitutional. Similarly to the CVS complaint, PCMA and Navitus' complaint calls Act 624 'unconstitutional economic protectionism, violating the foundational constitutional rule that states may not enact laws to benefit in-state economic interests by burdening out-of-state competitors.' PCMA and Navitus complaint 'This discrimination is not justified by any legitimate, non-protectionist local interest. Even if the state could articulate such an interest, the means chosen — categorically excluding out-of-state PBM-affiliated pharmacies — are not substantially related to the achievement of that interest and are far more restrictive than necessary,' PCMA and Navitus' complaint states. The complaint also calls Act 624 an unconstitutional bill of attainder, meaning it imposes a legislative punishment 'without the benefits and procedural safeguards of a judicial proceeding.' PCMA and Navitus' lawsuit claims that more than 40 pharmacies that cumulatively employ more than 600 Arkansans will lose their permits and be forced to close by the end of the year. CVS claims in its lawsuit that it will be forced to close 23 pharmacies that served more than 340,000 patients and filled over 2.4 million prescriptions in 2024. Express Scripts' complaint states that Act 624 'imperils the health' of the 50,000 Arkansans it serves, including members of the military, their families and veterans because the PBM is the primary mail-order pharmacy provider for Tricare, the military's health insurance program. Act 624 allows the state pharmacy board to issue limited permits to PBMs if they provide 'drugs that are otherwise unavailable in the market to a patient or a pharmacy that would otherwise be prohibited' under the law. Attorney General Tim Griffin reiterated a previous statement that he will defend Act 624 from its challengers. 'PBMs leverage their affiliated pharmacies to manipulate prices, corrupt the market, and destroy competition,' Griffin said, echoing the talking points of the law's supporters in the Legislature. SUPPORT: YOU MAKE OUR WORK POSSIBLE
