In 2015 and 2016, specialty net cost per claim had double-digit growth in the Medicaid fee-for-service (FFS) space, according to a new report from Magellan Rx Management. HIV/AIDS therapies led the specialty net spend for the second year in a row, with the average prescription net cost rising by almost 30% (see chart below). Six of the top 10 net spend drugs are in specialty classes: hepatitis C, hemophilia, HIV/AIDS and oral cystic fibrosis therapies.

According to the second annual Medicaid Pharmacy Trend Report, released Sept. 13, “With the exception of Hepatitis C Agents, these classes often lack clinical or financial management because of legislative protections, grandfathering, or pharmacy department policy. As witnessed with Hepatitis C Agents over the past three years, the cost of specialty drugs will eventually reach the tipping point where states will need to make difficult decisions about how to best allocate available resources in order to protect this most vulnerable patient population.”

The report is based on data from 22 Medicaid FFS clients across the country. Download the report at www.magellanrx.com.

HIV/AIDS Trend in Claim Volume, Net Cost per Claim, and Net Spend 2015-2016

HIV/AIDS Trend in Claim Volume, Net Cost per Claim, and Net Spend 2015-2016

SOURCE: Magellan Rx Management, Medicaid Pharmacy Trend Report, 2017 second edition. Released September 2017. Visit www.magellanrx.com.