High-Cost Drugs Fuel ‘Unsustainable’ Surge in Prescription Spend for Employers

Nomi Health analysis highlights the urgent need for cost-management solutions amid escalating healthcare expenses

Prescriptions now constitute about a quarter of total benefit spending in the United States, costing employers exponentially more every year and accelerating at a rate nearly four times faster than overall medical spend from 2022 to 2023, according to new data from Nomi Health, a direct healthcare company.

Nomi Health analyzed $23 billion in prescription drug claims from 11.5 million employees between January 1, 2022, and December 31, 2023 as part of its Trends in Spend series, which uses claims analysis data to call attention to key shifts in the financial impact of healthcare.

This retrospective cohort analysis was conducted by Artemis, a Nomi Health subsidiary whose benefits analytics platform is recognized as one of the most robust in the industry. Nomi Health’s Trends in Spend research also found:

• Prescription spending increased by an average of 10% yearly from 2020 to 2023. From 2022 to 2023, medical spending increased by 5%, while prescription spending soared by 18%. In 2022, the average cost employers paid — for all medications — was $450 per prescription.
• Biologics used to treat autoimmune and inflammatory disorders are the most expensive individual drugs contributing to prescription spend. Medications such as Humira, Remicade, Stelara, Dupixent, Cosentyx and Skyrizi accounted for 27% of total prescription spending between 2022 and 2023. These specialty drugs can average more than $35,000 per member per year and are consistently among the most expensive drugs for employers.
• Antidiabetic medications as a group now have a higher price tag than the costliest individual drugs and are the leading drug group contributing to employers’ prescription spend. This is fueled by the rapid growth in glucagon-like peptide 1 (GLP-1) agonists, including Ozempic, Wegovy and Mounjaro. GLP-1s accounted for 56% of the spending on antidiabetic drugs in 2023, up from 44% in 2022.
• Three drugs top the list by utilization. They are the antidiabetic Trulicy, antimigraine Sumatriptan and antidiabetic Mounjaro.

"Prescription spending is increasing too much, too fast — at a rate unsustainable for self-funded employers,” Nomi Health Co-Founder and CEO Mark Newman said. “This is a significant punch in the gut to a company’s finances, and yet, the damage goes beyond the balance sheet. This cost crisis threatens the quality of their employee benefits. Most of all, it's completely avoidable. There are solutions here and now that enable employers to cut prescription spending in half while making sure employees get the treatments they need.”

"With prescription costs spiking, self-funded employers have no choice but to take action, and they can look within their own data to identify potential savings,” Sanjay Motwani, president of Artemis by Nomi Health, said. “For example, biosimilars offer a prime opportunity. These biologic medication substitutes can be up to 50% cheaper, but many members still get the high-cost brand-name specialty drugs. For a company with 50,000 employees, even a modest shift towards biosimilars could mean annual savings of $300,000 to $500,000."

To read strategies ​​Nomi Health advises self-funded plan holders to consider to control prescription costs visit Nomi Health on LinkedIn.

For more information about Nomi Health visit nomihealth.com

Methodology

This is a retrospective cohort study based on an anonymized, aggregated set of 139.1 million prescription claims for 11.5 million insured members ages 0 – 102 from January 1, 2022, through December 31, 2023. Conducted by Artemis by Nomi Health, a leading benefits analytics platform, the analysis is the latest in the Nomi Health Trends in Spend Tracker series, which investigates costs associated with different healthcare topics to turn healthcare spending insights into meaningful actions.

About Nomi Health

Nomi Health is powering a healthcare system that prioritizes those who matter most. The company simplifies the business of healthcare with payment rails and programs built specifically for self-funded employers, governments, and their partners, such as TPAs, brokers, and consultants.

At Nomi Health, our long-term mission is to rebuild U.S. healthcare to run at half the cost. Nomi delivers actionable analytics, direct access to medical and pharmacy services, and real-time payment rails to transform how providers deliver great healthcare to plans and programs.

Artemis by Nomi Health uses data-driven insights to elevate their benefits strategy, offering companies actionable analytics to reduce spending, improve quality, and drive better outcomes for their members.

CerpassRx by Nomi Health combines industry-leading pharmacy tools and technology expertise with best-in-class PBM services and clinical offerings to create a boutique alternative to the traditional PBM model.

Founded in 2019, Nomi Health serves more than 3,200 customers nationwide, impacting 30 million lives and influencing over $150 billion in healthcare spend. Learn more at nomihealth.com.

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