Prescription Drug Utilization Trends: COVID-19 & Beyond

In any given year, following prescription drug utilization trends always has its challenges. It’s been especially interesting looking back on how COVID-19 has changed things, beyond its impact on the way that many of us work and interact with other people on a daily basis. There are a few key things to keep in mind as you evaluate your 2020 drug trend data:

• Changes in Enrollment – As the virus wreaked havoc on businesses and several industries across the country, we saw shifts up and down in member enrollment numbers. For those companies that were impacted, shifts in enrollment could mean a higher per member per month (PMPM) pharmacy benefits cost than what they had previously. As you evaluate any PMPM spikes over the last year, dig in a little deeper to see if it’s because of membership fluctuations and the prescriptions those members are using.
• Changes in Prescription Mix – While it could mean a shift in generic to brand drug medications, we are really interested in the shifts in acute vs. chronic condition prescriptions. With people sheltering in place for much of the year, we saw a clear reduction in prescriptions for the common cold, aches, and pains. These prescriptions typically are inexpensive generics or lower-cost brand drugs. Without those drugs in the product mix, the volume of drugs would be reduced but the change in the plan’s average PMPM cost may be substantial. This is likely to be a short-term phenomenon caused by the pandemic. We expect the number of prescriptions for acute conditions tick back up over 2021.
• Changes in Refill Rates & Quantities – Most of the pharmacy benefits managers (PBMs) relaxed their refill-too-soon policies in Q2 and Q3 2020 to ensure people had adequate quantities of essential medications on-hand. Much of that has now resolved, and trend is shifting back to 70%-80% refill rates. While we don’t see strong evidence of stockpiling, there was a notable shift from 30-day fills to 90-day fills. This trend will probably continue as we move forward because once people make that shift, they are more likely to stay with it.
• Changes in Progressive Trend Expectations – If you look at your trend from Q1 to Q2, Q2 to Q3, and so on, you normally see a natural progression of trend throughout the year. It’s a natural part of how benefits are designed today, with deductibles and people paying more in the beginning of the year. In 2020, however, we saw a discernable difference in how trend progressed. By December, it was beginning to shift back to what we consider a more normal range for the year but not quite back to net-neutral of what we expected without COVID-19. This is indicative – and encouraging – that we might be able to start the year with a trend pattern more in line of what we would normally see.

“The impact of COVID-19 can be felt across industries, and prescription drug utilization trends are no exception. It’s important to know what to look for as you review your 2020 pharmacy plan data.”

Mark Campbell, PharmD of RxBenefits

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The Bottom Line

Going forward, it will be important to analyze the plan’s prescription drug utilization data to understand what is driving the group’s specific trends and patterns. As you look at the data set, an important part of that analysis includes deciphering what was a result of COVID-19 and what is expected to be part of the group’s new normal. Only then can you begin to consider which clinical programs to put in place to manage appropriate utilization for 2021. With a still relatively uncertain future ahead as things slowly begin to normalize, your employer clients will need a risk management solution that ensures only the most clinically effective, lowest cost medications are being utilized. Independent clinical oversight from a pharmacy benefits optimizer can help them manage and reduce their pharmacy benefits spending, while preparing them for what’s to come.

Check out the Top Pharmacy Benefits Trends of 2020 On-Demand Webinar for more information about the latest prescription drug trends and strategies to address them.