Additionally, costs related to COVID-19 are likely to persist as we not only continue to treat and vaccinate against the virus, but also as prescribing practices evolve based on new data and published recommendations. The long-term effects of COVID-19 also will likely result in an uptick of prescribing of certain drug classes. Migraine headache, for example, is the most common reported neurologic symptom post-COVID, and prescribing patterns for prophylactic and abortive therapies is a trend to monitor.
The Early Stages of the COVID-19 Pandemic and Payer Response
As we reported in 2020, early trends seen in the pandemic included increases in outpatient prescribing of the latest COVID-fighting cocktail, with especially large increases seen in chloroquines (356% increased growth), azithromycin (85% increased growth), and supportive albuterol metered dose inhalers (201% increased growth). As previously noted, these increases were likely due to a combination of factors, including nationwide publicity of the medications or the presumption that these medications would help with COVID-19 symptoms.
As the pandemic continued, common formulary management strategies intended to discourage waste and potential abuse, such as dispensing or refill limits, were eased. These changes were put in place to improve patient access and minimize interruption in the daily operations of ambulatory clinics. Prescription coverage status (e.g., covered, not-covered) and coverage alerts (e.g., refill too soon, quantity limit exceeded, prior authorization required) have been considered friction points for both patients and prescribers long before the COVID-19 pandemic. With the reduction of these alerts early in the pandemic, an area of further investigation should consider evaluating key outcomes of plan beneficiaries whose prescription drug plans made the coverage modifications to ensure uninterrupted and safe access to medication therapies.
Through our work with a robust network of PBMs and health systems, RxRevu monitors prescribing trends on a quarterly basis. This data demonstrates how formulary and benefit information may change based on newly published guidance and the introduction of new therapies to market. For example, the formulary status for hydroxychloroquine was more likely to be flagged as “covered with restrictions, additional processing required” in 2021 as compared with 2020. This is possibly due to payer incorporation of NIH COVID-19 Guideline updates into formulary and benefit design that revoked the original March 2020 recommendation of hydroxychloroquine as a post-exposure prophylaxis therapy. Further evaluation has been done on US Insurer Spending on Ivermection Prescriptions for COVID-19. Our data shows insurers are utilizing formulary management strategies for COVID-19 prescription drug therapies to minimize wasteful spending for both patients and plans when evidence-based treatment has been shown to be ineffective.
Figure 1 below illustrates quarterly prescribing changes in 2021 and 2022 compared with 2020 for albuterol metered dose inhalers (MDIs), chloroquines, and azithromycin. Compared with 2020, prescribing for all four of these therapies drastically decreased in 2021, with the greatest decreases seen for chloroquine in all four quarters and hydroxychloroquine in Q2 through Q4. Evaluating the available data for Q1 2022, increased prescribing has been seen with albuterol MDIs and azithromycin compared with Q1 2021.
Figure 1. Real-Time Prescription Prescribing Trends for Select COVID-19 Therapies