County pharmacy report: specialty drugs, GLP‑1 use doubled in a year for some members

Navitus pharmacy executives Lisa and Brian reviewed calendar‑year 2024 pharmacy spending and utilization for the Mohave County trust. They reported total plan‑paid prescription spend of about $1.7 million for the 12‑month period and a plan‑paid per‑member‑per‑month pharmacy cost of $68.73, well below the Navitus public sector benchmark of $111.43.

Specialty drugs comprised 49.2 percent of plan paid specialty spend, and Navitus staff said the plan’s drug mix is concentrated: a small share of scripts (1.5 percent) account for about 60 percent of plan paid. Lisa and Brian explained that rebates and manufacturer assistance significantly lower net plan cost for some of the highest‑cost products.

Navitus highlighted aggregate trends in GLP‑1 antidiabetic drugs (the class that includes Mounjaro and Ozempic). The presentation showed Manjaro utilizers increased from 20 to 39 members in the 12‑month window presented; Ozempic increased slightly (25 to 27 utilizers). Presenters explained the clinical shift that has led prescribers to use GLP‑1s earlier in therapy and said Navitus has implemented prior‑authorization rules that require a confirmed Type‑2 diabetes diagnosis to cover GLP‑1s so the plan does not cover GLP‑1s used solely for weight‑loss indications (the presenter noted that the county’s plan excludes coverage for weight‑loss GLP‑1 medications such as Wegovy).

Rebates were an important line item: Navitus reported over $1 million in manufacturer rebates and additional savings from a manufacturer co‑pay assistance capture program that returned about $152,000 to the trust in the period presented. The presenters also noted the group’s generic dispensing rate (GDR) was 87 percent (benchmark 84 percent), a favorable measure.

Trustees asked how Navitus targets high‑cost members and whether specialty utilization was concentrated in single identifiable members; the Navitus clinical account executive said many categories had one or two utilizers and pointed to rebates as a major driver of net cost reductions for high‑priced agents. The board did not act on pharmacy program changes at the meeting.

Ending: The Navitus presentation underlined a common public‑employer pattern: a small number of members use expensive specialty drugs and an even smaller number of specialty utilizers can disproportionately affect plan pharmacy spend. Trustees asked follow‑up questions about utilization controls and manufacturer assistance programs.