Fact Based List:

Six Things to Know about Medical Benefit Prescription Spending

Submitted by Anonymous on Fri, 04/21/2017 - 10:23


  1. Spend for the commercial medical benefit increased 55% since 2011, while the Medicare medical benefit increased 5%.
  2. Commercial per-member-per month (PMPM) year over year allowed amounts increased 13% to $23.68. Medicare PMPM increased 2% to $46.01.
  3. Oncology and oncology support accounted for 44% of commercial spend ($11.23 PMPM), and 57% of Medicare spend ($26.04 PMPM).
  4. Of the top 10 categories, ophthalmic injections had the highest year-over-year trend, with commercial at 30% and Medicare at 39%.
  5. The 10 most expensive commercial medical benefit drugs averaged $421,220 annually per patient and affected 2 per 100,000 members.
  6. The 10 costliest Medicare medical benefit medications averaged $268,780 and affected 8 per 100,000 members.


Source: Specialty Pharmacy Times
Source URL: https://www.specialtypharmacytimes.com/news/annual-medical-p...



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