ORLANDO, Fla., April 8, 2014 /PRNewswire/ -- Expensive treatments for broad patient populations are driving unprecedented growth in U.S. spending on specialty drugs to treat complex conditions such as rheumatoid arthritis, multiple sclerosis and cancer, according to a new report issued today by Express Scripts (NASDAQ: ESRX).
As it has for the past two decades, the Express Scripts Drug Trend Report quantifies annual changes in utilization, unit costs and overall prescription drug spending, based on the pharmacy claims data from Express Scripts, the nation's largest pharmacy benefit manager. Released this week at the company's Outcomes Symposium in Orlando, the full report is available online at http://Lab.Express-Scripts.com.
While growth in specialty drug spend in 2013 – 14.1 percent – was at its lowest point in the past six years, it is poised to go up significantly. Express Scripts forecasts that the country's specialty-drug spend will increase an additional 63 percent between 2014 and 2016.
Hepatitis C Treatments Will Become Cost-Prohibitive
The leading driver of the steep spending forecast for specialty medications is hepatitis C, a disease affecting more than 2.7 million Americans. Due in part to the introduction of a new therapy that costs $84,000 per a 12-week course of treatment, Express Scripts forecasts that the U.S. will spend 1,800 percent more on hepatitis C medications in 2016 than it did in 2013. No major therapy class has experienced this high of a spending increase in the 21 years Express Scripts has measured drug trend data.
"Never before has a drug been priced this high to treat a patient population this large, and the resulting costs will be unsustainable for our country," said Steve Miller, M.D., chief, medical officer at Express Scripts. "The burden will fall upon individual patients, state and federal governments, and payers who will have to balance access and affordability in a way they never have had to before.
"The current pricing mentality around innovative products is unprecedented and unreasonable," said Dr. Miller. "Standing side-by-side with many of the country's largest plan sponsors, we are going to drive toward a pricing environment that is fair for patients, payers and manufacturers."
Specialty Medications: Increasing Costs for Small Patient Populations
While comprising less than one percent of all U.S. prescriptions, specialty medications in 2013 for the first time accounted for more than a quarter (27.7 percent) of the country's total pharmacy spend.
- Three specialty classes – inflammatory conditions, multiple sclerosis and cancer – accounted for 60 percent of total specialty spend in 2013.
- Treatments for inflammatory conditions, such as rheumatoid arthritis and Crohn's disease, continue to rank as the most expensive specialty therapy class, driven by brand price inflation of 15 percent in 2013.
- The therapy class that saw the largest percentage increase in spending during 2013 (39.2 percent) was central nervous system disorders, which includes treatments for Huntington's disease, narcolepsy and Parkinson's disease.
Traditional Medications: Diabetes is Costliest Drug Class for Third Consecutive Year
Spending on traditional prescription drugs – primarily pills taken to treat more common diseases such as high cholesterol and high blood pressure – increased 2.4 percent in 2013.
- With an increase in spending of 14 percent in 2013, diabetes was the costliest drug class for the third consecutive year. Express Scripts forecasts spending on diabetes drugs to have double-digit annual rate increases over the next three years, driven by a new pipeline of medications as well as price inflation for existing brand medications.
- Spending on compounded drugs more than quadrupled in 2013.
- Largely due to the coverage mandate within the Affordable Care Act, cost shifting led payers to spend 30.7 percent more on contraceptives in 2013 than in 2012.
- Spending on anti-infective medication increased 6.2 percent in 2013, due in part to drug shortages and resulting price increases for doxycycline and tetracycline.
- With increased generic competition, spending in seven key therapy classes – high blood cholesterol, high blood pressure/heart disease, ulcer disease, asthma, depression, mental/neurological disorders and infections – is expected to decline in both 2014 and 2015.
Medicare: Spending Flat for Traditional Drugs, Slower Growth for Specialty Drugs
For Medicare Part D plans in 2013, spending on traditional drugs remained flat, as an increase in utilization was offset by a decrease in unit cost. Spending on specialty drugs increased 14.7 percent in 2013, decelerating from a 24.1 percent increase in 2012.
- Diabetes, high blood pressure and high blood cholesterol accounted for more than a quarter of total Part D spending. Through its Star Ratings system, the Centers for Medicare & Medicaid Services (CMS) is focused particularly on the appropriate care for patients with these three conditions.
- The costliest specialty condition for Part D in 2013 was cancer, followed by multiple sclerosis and inflammatory conditions.
- Consistent with the commercially insured market, Part D spending on specialty conditions such as hepatitis C and central nervous system disorders is being driven by price inflation for medications that currently have little competition.
Medicaid: Most Vulnerable to Increasing Specialty Costs
Even in states not expanding their coverage per the requirements of the Affordable Care Act, Express Scripts anticipates that the greater awareness of Medicaid coverage is likely to have a dramatic effect on Medicaid prescription drug spend in the future.
- In 2013, diabetes overtook asthma as the costliest therapy class for Medicaid programs.
- HIV continues to be the costliest specialty therapy class for Medicaid programs.
- Spend on hepatitis C medications is expected to jump in 2014. Due to the greater prevalence of the disease among Medicaid beneficiaries, the high cost of the new therapies is expected to have an even more damaging impact for Medicaid programs.
About Express Scripts
Express Scripts (NASDAQ: ESRX) manages more than a billion prescriptions each year for tens of millions of patients. On behalf of our clients — employers, health plans, unions and government health programs — we make the use of prescription drugs safer and more affordable. Express Scripts uniquely combines three capabilities — behavioral sciences, clinical specialization and actionable data — to create Health Decision Science℠, our innovative approach to help individuals make the best drug choices, pharmacy choices and health choices. Better decisions mean healthier outcomes.
Headquartered in St. Louis, Express Scripts provides integrated pharmacy-benefit management services, including network-pharmacy claims processing, home delivery, specialty benefit management, benefit-design consultation, drug-utilization review, formulary management, and medical and drug data analysis services. The company also distributes a full range of biopharmaceutical products and provides extensive cost-management and patient-care services.
For more information, visit Lab.Express-Scripts.com or follow @ExpressScripts on Twitter.
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