Cost growth of services not subject to fee schedule caps has accelerated in recent years, driven largely by higher utilization.
Cost growth of services not subject to fee schedule caps has accelerated in recent years, driven largely by higher utilization.
Many states experienced higher medical payments, driven by higher prices for professional services and evolving trends in prescription drug utilization.
A 100% tariff is expected to take place August 1, 2028 for generic drugs imported into the U.S., followed by a 200% tariff in August 2029.
The Committee is focused on high-cost and high-utilization medications, including GLP-1s, PPIs, anticonvulsants, topical agents, and biologics.
While migraine drugs make up less than 1% of prescriptions, they now make up 7.5% of drug spend, primarily driven by CGRP drugs.
Pharmaceutical requests represented 30.6% of all treatment requests submitted for IMR, a modest decline from 32.7% in 2024.
Dermatological agents remained a significant cost driver, in part due to physician dispensing and delivery pharmacies, which accounted for a significant number of high-cost transactions.
Prescription drug list prices increased 23% in the last year, far outpacing inflation.
While opioid utilization has decreased, overall spend on pain management has increased, in part due to the use of high-cost topical medications.
While this drug class represents less than 1% of prescriptions, it accounted for 3.4% of drug spend.
The meeting discussed proton pump inhibitors and the need to review utilization, and future meetings will address GLP-1 drugs, migraine drugs, and more.
The report classifies distinct subgroups of injectable by medication type and identifies those most common in workers’ comp.
The report includes recommendations for providers, and the findings could impact rules around prescribing, utilization review, and service delivery.
Drug classes with the most new, high-priced drugs were anti-cancer drugs, ADHD/anti-obesity drugs, and anti-inflammatory pain medications.
Pharmacy service costs fell 40% - or $28 million dollars – from 2018 through 2023.
