Pharmacy MarketWatch: Stay in the Know

Premera Blue Cross has identified GLP-1s, cancer drugs, and shifts in drug spend as the consistent trends across pharmacy as the first quarter of 2024 ends.

Trend Drivers: 2024 Predictions

GLP-1s
We’re thinking about these drugs in three ways:

1. GLP-1s are highly effective, potent drugs for treating diabetes
2. GLP-1s are approved by the FDA to treat other conditions and that could impact our pharmacy trend
3. The GLP-1 pipeline is anticipated to grow significantly. Some drugs in the pipeline combine GLP-1s with other components to boost effectiveness or improve safety.

Cancer drug spend

The increased use of antibody drug conjugates (ADCs) will likely result in an increase in drug spend. ADCs are generally more expensive, more effective, and have fewer side effects. ADCs are designed to release a strong cancer killing payload on target cancer cells. These drugs are administered in the provider’s office and the ADC pipeline is anticipated to grow significantly.

Drug spend shift

The drug spend is shifting from the medical to the pharmacy benefit. Two examples of this shift include infusion drugs, Entyvio and Remicade, that now have new self-injectable options.

Pharmacy Newsroom

• First over-the-counter (OTC) continuous glucose monitor (CGM)
• • CGMs are small wearable devices that typically contain a needle and provide blood sugar management. CGMs require a prescription and are meant to be used by members with diabetes who require insulin. Stelo is a CGM designed for people with type 2 diabetes who don’t use insulin or for people without diabetes who may be curious how diet and exercise impact their blood sugar levels. OTC products, like Stelo, are not typically covered under the pharmacy or medical benefit.
• Legislative updates
  • Several new bills were signed into law in the latest Washington state legislature session. We’re currently reviewing each to understand impacts and implementation requirements. We’ll share more information as it becomes available.

• Biosimilars in the news
  • Simlandi is the first citrate-free, high-concentration, interchangeable biosimilar for Humira and was approved by the FDA on February 23, 2024. Simandi hasn’t been released to the market yet. More information to come about the Premera strategy regarding Adalimumab (Humira).