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.

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