Reports and Surveys | September 21, 2022

What Are the Projected 2023 Health Plan Cost Trends?

Medical plan cost increases for 2023 are returning to pre-pandemic levels, despite significant fluctuations as deferred care rebounded and COVID-19 variants peaked. While it’s anticipated that previously observed spikes related to COVID-19 should moderate over time, the long-term impact on health plan costs of new variants, treatments and long COVID is difficult to predict. The full impact of delayed or deferred care is still unknown.

One evident shift from the pandemic has been the greater adoption of virtual care/telehealthcare, with significant increases observed in those with mental health-related disorders being newly diagnosed and treated virtually. The shift appears to be permanent, although the long-term impact on health plan costs trends has yet to be properly quantified.

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For 26 years, Segal has conducted an annual survey of health plan cost trends to give plan sponsors information they need to help make decisions. During the summer of 2022, we surveyed managed care organizations, health insurers, PBMs and TPAs. Collectively, the survey respondents represent more than 80 percent of the commercially insured and self-insured market.

Key health plan cost trend findings

The key 2023 Segal Health Plan Cost Trend Survey findings about the coming year’s trend projections include:

  • The projected annual cost trend for outpatient prescription drugs is expected to be approaching double-digit levels, the highest rate observed since 2015.
  • Double-digit specialty Rx cost trend, mostly driven by price increases and new-to-market specialty drugs, continues to be a major driver of Rx cost trends.
  • Survey respondents project per-person cost trends for open-access PPO/POS plans to be 7.4 percent.
  • Provider price increases are still the primary driver for hospital, physician and Rx trends.
  • Trend projections for most dental coverages are expected to reach 4 percent, driven by inflation across the U.S.

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Key medical and pharmacy cost-management strategies

Plan sponsors may wish to consider these strategies as part of their medical cost management for 2023 and beyond:

  • Competitive bidding
  • High-cost patient case management and managing risk
  • Cost-management negotiation service for out-of-network services
  • Patient clinical tools and design

Effective options for managing pharmacy benefit costs include:

  • Plan design strategies
  • PBM contract review
  • Clinical controls

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This page is for informational purposes only and does not constitute legal, tax or investment advice. You are encouraged to discuss the issues raised here with your legal, tax and other advisors before determining how the issues apply to your specific situations.