LYNNFIELD, Mass., June 22, 2021 /PRNewswire/ — AMS, a healthcare IT company that provides clinical insights and financial analysis of the costliest and most complex medical claims, released their 2020 Specialty Drug Trends Report today, highlighting the need for predictive analytics to combat pervasive drug overspend.
AMS research reveals that payers are not being judicious with their specialty drug expenditures because they have little insight into the actual drivers of high-cost claims and members. Those drivers include cost increases, price transparency issues, and perhaps the fastest-growing area of pharmacy spend, utilization expansion. Detailed cost-driver reporting is needed for payers to alleviate high-cost claim overpayments and predict future liabilities.
Highlights of the report:
- Fewer than 2% of the U.S. population utilized specialty drugs
- Specialty drugs account for more than half (51%) of total drug spend
- 80% of annual medical trend increases were driven by specialty drug costs
- The top 10 Medicare Part B covered drugs accounted for 2% of all covered products but 43% of total Part B drug spending
Notable for this year’s report, specialty drug costs and trends sections were greatly expanded, allowing for greater depth & breadth of data. New charts filtered by Drug Category and Diagnosis/Disease (further segmented by cancers and non-cancers) provide additional intelligence surrounding the costliest pharmaceuticals impacting payer entities.
The report contains a review of 2020 specialty pharma spend, categorized costs (adult/pediatric and orphan), notable FDA approvals, and the most searched drugs and diagnoses via the company’s PredictRx and PredictDx modules. Also included is a downloadable PDF of 2020 FDA drug approvals added to PredictRx which incorporates pertinent clinical information and AMS Cost Projection (ACP) pricing.
“Our data shows us that specialty drug pricing continues to be one of the main cost drivers for high-dollar claims”, states Dr. Stacy Borans, AMS Founder and Chief Medical Officer. “As one can see from the report, specialty drug prices are high enough already. Even so, payers continue to misspend at alarming rates. Time and time again they pay reoccurring claims because they lack the tools and insights that ensure clinical and fiscal security.
Information and analytics for the report were derived primarily from two of several modules housed on AMS’ AI-driven Predict Platform: PredictRx (clinical and cost resource for specialty drugs) and FACS (payment intelligence and clinical integrity).
To request a copy of the 2020 Specialty Drug Trends Report click here.
AMS’ AI-powered Predict Platform is the industry’s first cloud-based enterprise software for healthcare affordability. Focused solely on the most expensive and complex claims, AMS forensically identifies, financially analyzes, clinically evaluates, and methodically predicts claims for the 5% of members responsible for 50% total medical spend. We believe that “Knowledge is Power”. www.mdstrat.com