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HOSPI TALS IN MULT IHOSPI TAL SYSTEMS
HOSPITALS/SYSTEMS DIGEST 2013
SANOFI / MANAGED CARE DIGEST SERIES
®
/ WHERE INFORMATION BECOMES INTELLIGENCE.
™
Key Takeaway
In spite of apparent efforts by MHS-owned plans to manage pharmacy utilization—fewer
prescriptions per member per year and a larger generic drug share in 2011—annual pharmacy
expenditures at these plans inflated at a faster rate than at their non-MHS-owned counterparts, as
did premiums. This rise resulted in more equitable family pharmacy premiums at the two plan types.
Pharmacy Utilization Drops for MHS-Owned HMOs in 2011
• For Medicare (to 26.8 from 27.0) and non-
Medicare (to 8.5 from 8.6) members alike,
the number of prescriptions dispensed per
year declined at HMOs owned by MHSs,
albeit fractionally, between 2010 and 2011.
• By contrast, non-MHS-owned HMOs dispensed a
higher number of prescriptions to non-Medicare
(to 9.5 from 9.4) and Medicare members (to
30.7 from 30.3) in 2011, both exceeding the
corresponding MHS-owned HMO averages.
PHARMACY
• In 2011, MHS-owned HMOs dispensed 8.5
prescriptions per non-Medicare member,
versus 9.5 at HMOs not owned by an MHS, the
largest differential in the six years shown.
• Individual pharmacy premiums for MHS-owned
HMOs ($35.97) were 12.0% below those of their
non-MHS-owned counterparts ($40.89) in 2011,
even after rising 10.9% from $32.43 in 2010.
Pharmacy utilization and expenses of HMOs, 2006–2011
Data source: IMS Health © 2013
Pharmacy utilization and expenses of HMOs
MHS-Owned
HMOs
Non-MHS-Owned
HMOs
ALL HMOs
Pharmacy MEASURE
2010
2011
2010
2011
2010
2011
# of Prescriptions per Non-Medicare HMO Member
8.6
8.5
9.4
9.5
9.3
9.4
# of Prescriptions per Medicare HMO Member
27.0
26.8
30.3
30.7
29.6
29.9
# of Prescriptions per Medicaid HMO Member
10.1
9.6
9.9
9.8
10.0
9.8
% of Prescriptions Filled with Generic Drugs
65.1% 68.1% 61.4% 61.2%
62.0% 62.3%
% of Prescriptions Filled with Brand Name Drugs
34.9% 32.0% 38.6% 38.8%
38.0% 37.7%
Pharmacy Expenditures as % of Total Operating Expenses
13.1% 13.0% 13.8% 14.0%
13.7% 13.9%
Pharmacy Expenditures per Member per Year
1
$529.36 $567.62 $567.50 $579.63
$561.96 $577.93
Ingredient Cost per Prescription
2
$51.24 $51.36 $59.13 $60.24
$57.92 $58.95
Individual Premium
$32.43 $35.97 $40.71 $40.89
$39.13 $39.97
Family Premium
$86.26 $99.61 $99.78 $101.86
$97.60 $101.51
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
Number of Prescriptions per
Non-Medicare HMO Member
$20
$26
$32
$38
$44
Individual Premiums
2006
2007
2008
2009
2010
2011
$30.95
$29.27 $30.15 $30.35 $31.00
$33.30 $32.53
$38.62
$32.43
$40.71
$35.97
$40.89
8.5
9.0
9.1
9.3
9.3
8.6
8.6
8.4
8.5
8.5
MHS-Owned HMOs
Non-MHS-Owned HMOs
MHS-Owned HMOs
Non-MHS-Owned HMOs
9.4
9.5
MHS-Owned HMO Members Fill Fewer Rxs and Pay Lower Premiums
LONG-TERM TREND
I...,24,25,26,27,28,29,30,31,32,33 35,36,37,38,39,40,41,42,43,44,...IV