Average employer-sponsored insurance (ESI) spending rose to $5,892 per person in 2018, according to the Health Care Cost Institute’s annual Health Care Cost and Utilization Report, which analyzes 2.5 billion medical claims to inform the public about trends affecting approximately 160 million U.S. individuals with employer-sponsored insurance. This spending growth outpaced 2017’s growth due to continued price growth combined with an uptick in utilization.
“Prices, spending, and out-of-pocket costs continue to rise for the 160 million Americans with employer-sponsored health insurance,” said Niall Brennan, president and CEO of HCCI. “Higher prices for medical services continue to drive most spending increases, but in 2018 we also saw an uptick in utilization for the first time in several years. If these price and utilization trends continue, we expect spending growth to stay on an upward trajectory in the coming years.”
Despite recent increases in utilization, rising prices were the primary driver of spending growth over the 5-year study period. After adjusting for inflation, spending rose by $610 per person between 2014 and 2018. “Higher prices for medical services were responsible for about three-quarters of overall spending increases between 2014 and 2018, after inflation,” said Jean Fuglesten Biniek, report co-author and senior researcher at HCCI.
Becker’s Hospital Review lists the 20 most expensive prescription drugs in our country according to the prescription drug discounter, Good Rx. Topping the list is “Amryt Pharma’s drug, Myalept, used to treat lipodystrophy, with a list price of $71,206 per month.” The Children’s Hospital of Philadephia explains that
Lipodystrophy is a rare disorder that affects how the body stores and uses fat. Children with lipodystrophy may have little or no body fat. Instead, fat builds up in places it shouldn’t, like the blood and internal organs. This can lead to diabetes and other health problems.
Lipodystrophy can be inherited, which means the condition is passed down from the parents and it can develop at any time in life. Lipodystrophy can also be acquired without a known genetic cause.
Three medical directors of major health plans have explained in the Washington Examiner why heath plan prior authorization practices are smart medicine. They don’t have to convince the FEHBlog but their article may be helpful to health plans in rebutting physician complaints.