Therapy for chronic migraine — a condition that’s been notoriously difficult-to-treat and which often leads to significant direct and indirect health care costs — has been upended with the recent approval of three injectable monoclonal antibody products in a new preventive medication class that’s significantly more effective than older preventive migraine drugs, a researcher says.

Orphan drugs are a fast-growing component of health plans’ drug spend, and controlling utilization while ensuring appropriate patients have access requires plans to put in place a multi-pronged strategy that encompasses site-of-service interventions, provider education and innovative contracting, experts say.

At a recent roundtable in Washington, D.C., Wall Street analysts posited that vertical integration among insurers, PBMs and retail pharmacies is likely to reap rewards, managed care organizations must enhance their work with large employers, and more insurers likely will sell short-term insurance products. The analysts expect MCOs will continue to focus on Medicare — and also on Medicaid managed care, well beyond the program’s potential expansion opportunities.

by Jinghong Chen

Nationwide, the average total health benefit cost per employee climbed 3.6% in 2018, up from a 2.6% increase in 2017, according to Mercer’s 2018 National Survey of Employer-Sponsored Health Plans, released Oct. 30. Smaller employers with 10 to 499 employees faced higher cost increases, averaging 5.4%. A third of covered employees are currently enrolled in account-based consumer-directed health plans (CDHPs). Looking ahead, midsized and large employers identified “managing high-cost claimants” and “creating a culture of health” as the top priorities for the next five years.