The report reveals insights on traditional drug benefits, rising demand for GLP-1 drugs, and the impact of cost sharing and program structures

Pharmaceutical Strategies Group (“PSG”), an EPIC company, released its annual Trends in Drug Benefit Design Report, sponsored by Prescryptive Health, detailing the trends and leading strategies for traditional drug benefits. The research provides valuable insights about drug benefit design and management.

Management of the pharmacy benefit continues to be a critical aspect of U.S. healthcare, and this report provides insights on how healthcare payers evolve their pharmacy benefit strategies over time and respond to market events like the rise of GLP-1s. In this environment, decisions about program structure, cost sharing, drug access and pricing, formulary design and management, and clinical and trend management are more numerous and complicated than ever.

“The pharmaceutical industry is highly dynamic and at times overly convoluted. Healthcare payers need insights in terms of how organizations like theirs are responding to these constantly evolving market trends,” said Michael Lonergan, President of PSG. “I'm pleased to once again provide an independent and unbiased view for both healthcare payers and the broader industry of the perspectives of health plans, employers, and other healthcare payers.”

The report includes these key findings:

• 1 in 4 health plans are moderately or very likely to pursue an unbundled PBM services arrangement
• The top desired improvement for utilization management programs is more transparency and accountability regarding costs and outcomes
• 22% of plans have a process for tracking health disparities among plan members
• Employers are moderately concerned about the impact of high list price/high rebate drugs on their high-deductible health plan members

A major focus of the report is GLP-1 drugs for type 2 diabetes and obesity. "This research highlights the complexities presented by the rapid acceleration of GLP-1 drugs,” said Morgan Lee, PhD, MPH, CPH, Senior Director, Research and Strategy at PSG, who was the lead researcher on the report. “From coverage decisions to concerns about affordability and off-label use to cost containment strategies, plans have more to consider than ever before. As GLP-1s are approved for additional indications, this will continue to grow."

Important findings around the growth of GLP-1 drugs include:

• Over 90% of plans cover GLP-1 drugs for type 2 diabetes, while just over 30% cover these drugs for obesity.
• About three-quarters of plans have experienced increased GLP-1 drug spend in recent months.
• The most common strategies used to control costs related to coverage of GLP-1 drugs for obesity are prior authorization and a BMI requirement.
• Most plans are moderately or very concerned about affordability of GLP-1 drugs and off-label use of GLP-1 drugs approved for diabetes.
• The top reason for excluding GLP-1 drugs for obesity from coverage is belief that it would be too expensive to cover these drugs for all members for whom they would be prescribed.

“As a healthcare technology company, we believe that empowering patients to make informed choices is critical to addressing some of the most difficult issues facing the industry today,” said Chris Blackley, co-founder and CEO of Prescryptive Health. “We are energized to see results that indicate that employers and health plans are ready to drive patient-focused change and are open to adopting new approaches to improve medication access, affordability, and value.”

Download the Trends in Benefits Design Report and register for the webinar reviewing the findings here.

About the 2024 Trends in Drug Benefit Design Report

The Trends in Drug Benefit Design Report provides in-depth insights into traditional (non-specialty) drug benefit trends and strategies and focuses on drug benefit design for the 2024 benefit year among employers, union/Taft-Hartley, and health plan respondents. The survey sample informing this report included 223 benefits leaders. Issues specific to specialty drugs are included in a separate report — Trends in Specialty Drug Benefits. This report, as well as prior annual reports conducted by PSG, can be found at https://www.psgconsults.com/research.

About Pharmaceutical Strategies Group (PSG)

Pharmaceutical Strategies Group, an EPIC company, relentlessly advocates for clients as they navigate complex and ever-changing drug cost management challenges. PSG is an independent consultant, empowering healthcare payers to manage their pharmacy program better. As a strategic partner, PSG helps clients by providing industry-leading intelligence and technologies to realize billions of dollars in drug cost savings for clients every year. www.psgconsults.com

About Prescryptive Health

Prescryptive Health is a healthcare technology company rewriting the script for the US pharmaceutical market. We are building a more equitable and transparent ecosystem that connects patients, prescribers, pharmacies, payers, and pharma manufacturers, empowering consumers to take ownership of their prescriptions. Our solutions optimize health outcomes while enabling better patient engagement through user-friendly technology. Find out more at Prescryptive.com or on LinkedIn. #letsrewritethescript

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