Archived Insight | November 1, 2018

2019 Segal Health Plan Cost Trend Survey

Medical and prescription drug cost trends, for both actives and non-Medicare retirees, are projected to be lower in 2019 than in previous years.

That’s the headline finding from Segal’s 2019 Health Plan Cost Trend Survey, which surveyed more than 100 managed care organizations (MCOs), health insurers, pharmacy benefit managers (PBMs) and third-party administrators (TPAs).

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Key Findings

  • Medical plan cost trends are projected to be lower than 2018 projections.
  • Actual medical and prescription drug trend results for 2017 were significantly lower than carrier projections for 2017.
  • Actual prescription drug plan cost trends for 2017 were the second lowest in the last 13 years.
  • Price inflation continues to be the primary driver of overall medical and prescription drug cost trends.
  • Network physician reimbursement rate increases are projected to increase by less than 2 percent for both primary care and specialists, below overall CPI rates.
  • Prescription drug cost-management strategies and improved vendor contracting are still plan sponsors’ top priorities.
  • We cover each key finding in the full report.
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Prescription drug cost-management is still a top strategy.

Plan sponsors continue to use various cost-management strategies to grapple with ever-escalating health plan costs.

We asked the survey participants to rank the cost-management strategies implemented by group health plans in 2018. Here are the top five, compared with 2017.

Prescription Drug Cost Management Continues to Be Plan Sponsors’ Highest Priority Strategy

2018 Top Five

2017 Top Five
  1. Using specialty pharmacy management tools or techniques
  2. Intensifying pharmacy management program
  3. Adding low-cost primary care access
  4. Contracting with value-based providers
  5. Opioid abuse prevention management
  1.  Using specialty pharmacy management tools or techniques
  2. Intensifying pharmacy management program
  3. Contracting with value-based providers
  4. Increasing financial incentives in wellness design
  5. Adopting an HDHP

 

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In the full report, you’ll find examples of further strategies, based on our extensive surveying. We also cover where to focus cost-management efforts.

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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.