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Navitus Achieves Double-Digit Savings for New Clients in 2019

  • May 28, 2020
  • PBM Model
As appeared in AIS Health’s RADAR on Drug Benefits on May 28, 2020.

Navitus Health Solutions, a PBM that touts a 100% rebate pass-through model and a lowest-net-cost formulary, says it is seeing success in moderating total net cost per-member per-month (PMPM), particularly for new clients.

The company’s 2019 Drug Trend report, released in May, said Navitus achieved an “industry-leading” total net cost PMPM of $78.12 across its commercial business, 16% lower than the forecasted industry average of $93.11 PMPM.

Success with this model is due to the PBM’s transparent, pass-through business strategy, and the effect is cumulative, says Tom Pabich, senior vice president of business development and client services for Navitus. “For the past five years, from 2015 to 2019, we actually generated long-term savings with that cumulative effect of $64.77 PMPM over some of the published industry averages,” Pabich tells AIS Health.

Drug utilization changes in a beneficial way when the PBM makes decisions based on a lowest-net-cost philosophy, adds Brent Eberle, chief pharmacy officer. “We see utilization mix changes that result in the use of more generics, more lower-cost brands, and the elimination of waste from a client’s formulary,” he says.

Clients who were new to Navitus in 2019 saved an average of 25% in drug spend over their 2018 results, the drug trend report said. Hospital systems saved 30% on average, while new government clients saw 20% savings over 2018, and employers saved 22% relative to 2018. Eberle says some new clients may see more savings from receiving more rebates, while others might benefit more from improved utilization.

Utilization Rises for Maintenance Meds
The report found that the top 10 drug categories — dominated by medications used to treat autoimmune diseases (anti-inflammatory and dermatological categories), diabetes, cancer, multiple sclerosis and HIV/hepatitis C antivirals — accounted for 68% of overall costs, up from 61% in 2018.

Meanwhile, maintenance medications for chronic conditions accounted for 77% of total dispensed days of therapy. Utilization was up around 3% for maintenance medications, suggesting improved member adherence, the report found. Maintenance medications in particular therapeutic areas stood out:
  • Increasing utilization of GLP-1 and SGLT-2 inhibitors drove up the overall trend for diabetic medications. “Outcomes data showing lowered risk of cardiovascular and kidney disease for these products have moved them up in guideline recommendations and now they are often considered after metformin,” the report said.
  • Spending for antivirals to treat HIV continues to move upward in the wake of price increases for branded medications, plus utilization increases for pre-exposure prophylaxis (PrEP), the report said, noting that better access to PrEP ultimately should lead to lower rates of infection.
  • Increased competition in the in- haler market has driven costs down for the asthma medication class.
  • Treatments for attention deficit hyperactivity disorder, anticonvulsants and antidepressants are seeing a decrease in costs, which is linked to generic availability.
  • Non-specialty dermatological drug costs dropped by double digits for the sixth consecutive year “as a result of aggressive formulary management, including tighter controls on high-cost topical products such as corticosteroids and analgesic formulations,” the report said.
  • Opioid utilization continued to decrease, dropping 16.5% from 2018. Navitus credited its Opioid Safety Solutions suite of tools, which includes drug utilization reviews, reporting and compliance programs, and member engagement/educational efforts.
  • Specialty utilization continued to increase in 2019, rising 14.7%. Specialty trend was up 13.1%, moderated by a 1.6% decrease in unit cost, Navitus said. The four top specialty drug categories, including anti-inflammatory and analgesics, antineoplastics, multiple sclerosis medications and dermatologicals, accounted for 66% of specialty spend, the report found. Dermatological utilization rose 58%, driven by products for plaque psoriasis and atopic dermatitis, while “savings are being seen in the psychotherapeutics class with the continued price decreases in generic glatirimer and dalfampradine,” the report said. Antineoplastics grew 14.4%, growth hormone and metabolic agents grew 13.9%, and hematological agents grew 95.5%, according to Navitus.
The PBM’s Respiratory Health program showed good results, improving condition target levels for 28% of members with asthma and 21% of members with chronic obstructive pulmonary disease, the report found. In addition, Navitus achieved an average adherence rate of 91% (based on the proportion of days covered) through its specialty pharmacy program.

Navitus also generated client savings of between 3% and 5% off retail drug spending by using its narrow network management option, with some clients saving as much as 10%, according to the report.

Pandemic Alters Drug Spending
As 2020 progresses, Navitus is seeing effects from the COVID-19 pandemic overtake some of its other trends, Eberle says. “We saw some very high increases in the asthma category that we wouldn’t have been expecting, as well as in the antivirals, with some spikes with hydroxychloroquine,” he says.

The PBM also saw above-average early refills in March, but then observed a reversion to even below normal levels in April and May, with a decrease in new prescriptions and in new prior authorization requests. Eberle adds, “But we also are feeling there’s probably now a growing built-up de- mand that is likely going to hit over the summer.” Navitus is preparing for that now, he says, by “educating clients about what we’re seeing in their data, helping them to forecast different scenarios that may happen throughout the year, [such as] what does it look like if there is another spike?”

Copyright © 2020 by AIS Health, a division of Managed Markets Information & Technology, LLC. Reprinted with permission from AIS Health, an MMIT company,

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