[P]rescription drugs have an increasing impact on health insurance costs in Vermont, and high-priced speciality drugs are leading the way.

A new report from the Green Mountain Care Board says prescriptions were responsible for nearly 16 percent of premiums in 2018 for three insurers – Blue Cross and Blue Shield of Vermont, MVP Health Care and the Vermont Health Plan.

That’s an increase from the previous year. And speciality drugs were the biggest culprit, accounting for a larger percentage of premium costs than both brand-name and generic drugs.

“Drug prices are one of the most rapidly increasing health care costs over time,” said Sara Teachout, a Blue Cross spokesperson.

With rising prescription drug costs a primary focus of state and federal policymakers, the care board report’s price findings are not a big surprise.

And there are limitations on the board’s data. For instance, the study does not factor in rebates and discounts offered by drug manufacturers, and it examines only plans regulated by the care board.

Also, Blue Cross said the data include only drugs distributed through retail pharmacies – not in medical settings like a hospital.

But the report – which is a product of Act 193, a drug-price law passed by the state Legislature earlier this year – does provide a snapshot of the most-prescribed and highest-cost drugs covered by the state’s private insurers for more than 95,000 Vermonters.

“It also provides important pharmacy cost information that our members can use to make informed decisions, together with their physicians, on medication choices,” said Jim Hopsicker, MVP’s senior leader of pharmacy strategy and management.

Using average wholesale prices as of January 2018, the care board found that prescription drugs accounted for $81.65 in monthly premium charges per consumer. That’s up 11.4 percent from the previous year.

Those percentages varied for each insurer. Blue Cross saw the highest overall premium increase in 2018 due to prescription drugs, at 12.8 percent, while MVP posted a 10.8 percent increase.

The Vermont Health Plan showed a 15.3 percent decrease in premiums attributable to prescription drugs. But the plan – a health maintenance organization owned by Blue Cross – covered only 2,800 consumers included in the care board’s study.

Speciality drugs boosted premiums for all three insurers. Defined by the care board as “high-cost, complex drugs and biologics typically used to treat chronic, serious or life-threatening conditions,” speciality prescriptions accounted for an average $40.44 in monthly premiums for consumers.

Blue Cross was hit the hardest, reporting a 23 percent increase in the cost of speciality prescriptions last year. “You can see that speciality is really driving this,” Teachout said.

The drug with the biggest impact on insurance costs was Humira, an anti-inflammatory used to treat conditions like arthritis, Crohn’s disease and psoriasis. Humira accounted for 1.4 percent of premiums, the care board says.

The other two specialty drugs with the largest effects on insurance premiums were Harvoni, which is used in hepatitis C treatment, and Enbrel Sureclick, another anti-inflammatory used for arthritis and psoriasis. Harvoni accounted for 0.78 percent of premiums, while Enbrel was 0.7 percent.

Both Blue Cross and MVP cautioned that the prices in the care board’s report don’t easily translate into actual prices paid by any given consumer.

Teachout said “plan design impacts the way individuals pay for their prescriptions,” so prices vary based on factors like co-payments and out-of-pocket maximums.

The care board acknowledged that manufacturer rebates, which are subject to confidential contracts, “are a significant factor in the price consumers pay for prescription drugs.”

MVP sounded a similar note.

“MVP is mindful of the rising costs of prescription drugs and how those costs affect individuals and families,” Hopsicker said. “We work diligently to take steps to protect our members from rising costs, including contracting with a pharmacy benefits manager that negotiates rebates with manufacturers, which are then passed on to members.”