The second part of Coventry’s “2017 Drug Trends Series” has been released, this one focusing on managed versus unmanaged utilization of prescriptions. The managed data takes the traditional view of retail and mail-order, and adds prescriptions from their extended network. The unmanaged data represents out-of-network prescriptions that are received and processed through bill review.

The managed data represents 72.6 percent of all prescriptions and 77.9 percent of total cost in 2017, and provides a more accurate portrayal of managed pharmacy trends because of the prescription data captured through their extended network (accounting for 5.8 percent of all prescriptions and 7.4 percent of total costs). The unmanaged data represents 27.4 percent of all prescriptions and 22.1 percent of total costs.

They found that overall, utilization was down. Opioid utilization decreased by 1.2 percent for managed populations (accounting for 28.9 percent of total prescriptions) and 1.8 percent for unmanaged (accounting for 10.8 percent of all prescriptions). Compound utilization also decreased, by 0.2 percent for managed populations (accounting for just 0.2 percent of all prescriptions) and 2.8 percent of unmanaged (Accounting for 1.3 percent of all prescriptions). However generic utilization increased by 1.1 percent for managed populations (accounting for 86.8 percent of total prescriptions) and 2.6 percent for unmanaged (accounting for 81.8 of total prescriptions).

Prescription utilization per claim was down for both populations, 5.9 percent for managed and 7.4 percent for managed. Opioid utilization decreased 9.8 percent for managed and 20.7 percent for unmanaged. Compound utilization per claim decreased significantly, 51.8 percent in managed populations and 70.9 percent for unmanaged. Coventry attributes the decrease in compound and brand-name drugs to their compound management solution for both populations.

They did find that expensive private-label topical prescriptions are contributing to a rise in unmanaged topical utilization per claim (an increase of 9.8 percent for that population and ranked first in overall cost).

There are differences between managed and unmanaged groups that are worth pointing out. The average claim age for managed populations is 5.4 years, the average for unmanaged is 1.6 years. The average percentage of claims with more than one fill for the managed group was 61.2 percent, it was 29.8 percent for unmanaged groups.

The analysis is based on calendar-year transactions billed through their Pharmacy Benefit Management (PBM) program, First Script, in addition to transactions from medical bill review.

Read the full report from Coventry here.