Diabetes and Weight Loss Drugs Drive Trend in Employer Market Report

The employer market experienced a double-digit increase in overall pharmacy trend in 2022, according to Magellan Rx Management’s recent Employer Market Insights Report. Specialty drugs and increased used of therapies to treat patients with diabetes and weight-loss contributed to the increase. But Magellan forecasts that the specialty trend will be considerably lower during the next three years primarily due to the market entry of biosimilars.

Karim Prasla

“Leading with actionable data, we will continuously assess marketplace events to proactively identify opportunities and deliver solutions that effectively manage traditional and specialty drug spend,” Karim Prasla, vice president, clinical outcomes, advanced analytics, and research for Magellan Rx, said in a press release.

The pharmacy trend in the employer market experienced an overall trend of 14.4%. Traditional pharmacy trend increased by 10.5%, driven primarily by increased utilization for diabetes and obesity drugs. In recent years, the Magellan report said, traditional pharmacy had experienced flat and even negative trend.

Diabetes and weight loss drug are driving employer trend, with weight loss drugs comprising 20% of overall trend and 76% of traditional drug trend. The mainstream attention the GLP1s are receiving is driving that trend, a spokesperson for Prime Therapeutics said. Last year, Prime Therapeutics acquired Magellan, but the data used for this report pertains only to clients managed by Magellan Rx in 2021 and 2022 and doesn’t include any legacy Prime data.

For Magellan’s clients, Ozempic (semaglutide) had the highest trend of any product in 2022, and Wegovy (semaglutide) was the fifth highest drug in terms of trend. Diabetes as a whole is expected to become the top condition by 2024 with a per member per month cost of $22.21. Asthma and chronic obstructive pulmonary disease (COPD) will remain the second leading condition until 2024, but Magellan expects that by 2025, anti-clotting drugs will surpass asthma/COPD and have a per member per month spend of $5.19.

Drugs such as Ozempic which is approved to treat patients with diabetes, have gotten a lot of attention because of their ability to help with weight loss, and some have been used off-label for that purpose. Wegovy and Saxenda (liraglutide) are GLP-1 products approved for weight loss. All three products work by mimicking a hormone that targets areas of the brain that regulate appetite and food intake.

Most of Prime’s clients tend not to cover medications for non-FDA approved indications, the spokesperson said. Magellan Rx’s employer business clients cover Ozempic as a preferred brand for diabetes, and Wegovy is a nonpreferred brand for weight loss with prior authorization being required for both drugs. But not all clients opt to cover weight loss management and Wegovy, the spokesperson said.

Related: Real-World Study Finds Low Patient Adherence for Weight Loss Drugs

A recent analysis by Prime found that patients taking weight loss drugs such as Wegovy and Saxenda had low patient adherence and higher total cost of care. At one year, 68% of patients who had started taking these drugs for weight loss were no longer taking the medication.

By 2025, diabetes drugs will surpass autoimmune and anti-inflammatory therapies in terms of spend. This will be because of the savings from Humira (adalimumab) biosimilars, in addition to guideline changes from GLP-1s, the spokesperson said.

Specialty trend in the employer market experienced a trend of 17.9%, primarily due to an increase in utilization. But specialty pharmacy trend is in the early stages of experiencing a shift due to the launch or expected launch of biosimilars for Humira and Stelara (ustekinumab), which could provide savings. The anti-inflammatory therapies are expected to be around $20 in per member per month cost, which would be down from $23.46 in 2022.

There could be up to $124.5 billion in savings through 2025 from adoption and use of all biosimilar products, including the Humira biosimilars, according to a projection published earlier this year in the American Journal of Managed Care.

Janssen’s Stelara has a list price of $25,497.12 every eight weeks. It is approved to treat moderate-to-severe psoriasis, psoriatic arthritis, Crohn’s disease and ulcerative colitis. Several biosimilars for Stelara are under regulatory review or in development. Amgen’s biosimilar referencing Stelara, however, has been delayed until 2025.

AbbVie’s Humira has a list price of $6,922 for a four-week supply, and is indicted for patients with rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, Crohn’s disease and ulcerative colitis. The eight Humira biosimilars that have recently launched could have a positive impact on spend, the report suggests. Some off these biosimilars offer significant discounts. Yusimry (adalimumab-aqvh) from Coherus BioSciences and Hadlima from Organon/Samsung Bioepis have launched at a price that is a discount of about 85% off Humira.

Prime is recommending that its commercial clients include the following biosimilars:

• Amgen’s Amjevita (low concentration) and Boehringer Ingelheim’s Cyltezo (interchangeable, low concentration); or
• Amjevita (low concentration) and Hadlima (high and low concentration)

For Medicare Part D formularies, Prime is recommending Cyltezo (interchangeable, low concentration).

Amjevita is being offered at two price points: 5% and 55% below Humira, and Cyltezo is offered at a price 5% to 7% below Humira.

Magellan’s report also suggests that oncology is expected to remain the second leading condition in specialty pharmacy, with a per member per month of about $9 by 2025. Atopic dermatitis is expected to become the third top specialty category by 2025, costing about $3.66 per member per month.