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HOSPI TALS IN MULT IHOSPI TAL SYSTEMS
HOSPITALS/SYSTEMS DIGEST 2015
SANOFI / MANAGED CARE DIGEST SERIES
®
/
WHERE INFORMATION BECOMES INTELLIGENCE
.
™
Key Takeaway
In 2013, MHS-owned HMOs dispensed fewer prescriptions per Medicare and non-Medicare member
alike than their non-MHS-owned counterparts. Generic drugs also made up a smaller share of
total drugs prescribed for the former than the latter. Yet MHS-owned HMOs had lower ingredient
costs, expenditures per member per year and drug costs as a percentage of total operating costs,
perhaps reflecting greater market leverage and/or less susceptibility to market fluctuations.
Generic Portion of Non-MHS-Owned HMO Rxs Increases
• The generic share of prescription drugs
dispensed to members of non-MHS-owned
HMOs in 2013 (77.5%) grew nearly two
percentage points from 2012, but it edged
down 0.6 points among MHS-owned HMOs.
• Meanwhile, pharmacy expenditures as a
percentage of total operating costs rose to
15.0% from 14.7% for non-MHS-owned HMOs
and to 13.2% from 13.1% for MHS-owned HMOs.
Overall, this portion grew to 14.7% from 14.5%.
PHARMACY
• From 2007 to 2013 individual pharmacy benefit
premiums climbed 38.8% (to $42.12 from
$30.35) in non-MHS-owned HMOs, versus 16.1%
in MHS-owned HMOs (to $34.99 from $30.15).
• The average number of prescriptions filled per
non-Medicare member of non-MHS-owned
HMOs was the same in 2013 (9.1) as it was in
2007. In MHS-owned HMOs, it rose to 8.8 from 8.5.
PHARMACY UTILIZATION AND EXPENSES OF HMOs, 2007–2013
Data source: IMS Health © 2015
PHARMACY UTILIZATION AND EXPENSES OF HMOs
MHS-Owned
HMOs
Non-MHS-Owned
HMOs
ALL HMOs
PHARMACY MEASURE
2012
2013
2012
2013
2012
2013
# of Prescriptions per Non-Medicare Member per Year
8.6
8.8
9.2
9.1
9.1
9.0
# of Prescriptions per Medicare Member per Year
26.2
27.2
30.1
30.0
29.3
29.4
# of Prescriptions per Medicaid Member per Year
9.6
9.6
9.5
9.6
9.5
9.6
% of Prescriptions Filled with Generic Drugs
72.8% 72.2% 75.7% 77.5%
75.2% 76.6%
% of Prescriptions Filled with Brand Name Drugs
27.2% 27.8% 24.3% 22.5%
24.8% 23.4%
Pharmacy Expenditures as % of Total Operating Expenses
13.1% 13.2% 14.7% 15.0%
14.5% 14.7%
Pharmacy Expenditures per Member per Year
1
$605.35 $568.51 $604.46 $616.30
$604.60 $609.00
Ingredient Cost per Prescription
2
$50.46 $50.44 $56.68 $57.83
$55.73 $56.70
Individual Monthly Pharmacy Benefit Premium
$36.89 $34.99 $40.98 $42.12
$40.21 $40.71
Family Monthly Pharmacy Benefit Premium
$98.77 $87.55 $102.41 $106.56
$101.80 $103.04
1
Expenditures do not include administrative and copayment costs.
2
This average is derived by dividing HMO pharmacy expenses by the total number of prescriptions dispensed. Expenses do not include
administration and copayment costs.
8.2
8.6
9.0
9.4
9.8
$20
$26
$32
$38
$44
Individual Premiums
2007
2008
2009
2010
2011
2012
2013
$30.15 $30.35 $31.00
$33.30 $32.53
$38.62
$32.43
$40.71
$35.97
$40.89
$36.89
$40.98
$34.99
$42.12
8.5
8.4
8.6
8.6
8.5
8.6
8.8
9.1
9.3
9.3
9.5
9.2
9.1
# of Prescriptions per
Non-Medicare HMO Member
MHS-Owned HMOs
Non-MHS-Owned HMOs
MHS-Owned HMOs
Non-MHS-Owned HMOs
9.4
Number of Rxs Dispensed in Non-MHS HMOs in 2013 Is the Same as in 2007
LONG-TERM TREND