Specialty Drugs Accounted for Half of Medicaid Spending in 2020

Specialty drugs accounted for 51.4 percent of the net cost in Medicaid and 1.3 percent of utilization in 2020, according to a Magellan Health trend report.

The Medicaid Pharmacy Trend Report looked at the evolving landscape of Medicaid, including an in-depth analysis of class and drug trends, forecasting, drugs in the pipeline, and pharmacy economics, all of which have developed even more from the events of the last two years. 

Researchers collected data from programs in 25 states and the District of Columbia. 

In 2020, the traditional new cost trend for Medicaid FFS was positive for the first time in five years with the introduction of new-to-market drugs, researchers said.

For example, specialty drugs such as hepatitis C therapy, Mavyret, and Trikafta (a combination therapy for cystic fibrosis) represented the highest net dollar impact in their categories. And last year also saw an increased gross cost per claim and net cost per claim of 8.5 percent and 8.9 percent, respectively. 

The report highlighted that a majority of the Medicaid fee-for-service (FFS) drug trends remained steady. But the drug pipeline forced states to consider alternative pathways to continuity of care for patients, especially on technology-based solutions.

Medicaid FFS top drug classes were similar to previous years, with HIV/AIDS and antipsychotics accounting for over 19.8 percent of total net drug spend. And the top five classes accounted for nearly 40 percent of total net spending. 

Researchers concluded that most key conditions will experience an increasing trend over the next three years, with a steady increase in the pipeline. And conditions with generic drug introductions or specialized management strategies will see a decrease. 

“As our nation continues to navigate the lasting impacts of the COVID-19 pandemic, there is no doubt that states are facing unprecedented challenges across all areas of government,” Meredith Delk, PhD, MSW, general manager and senior vice president of government markets at Magellan Rx Management, said in the report. 

“The Medicaid Trend Report illustrates critical data-driven observations and solutions. The valuable insights in this report can assist states on their mission to ensure a high quality and cost-effective prescription drug program for their most vulnerable populations,” Delk concluded.