Express Scripts Report Highlights Top 3 Drug Spending Areas for 2016

Express Scripts, the largest pharmacy benefit manager (PBM) in the U.S., released a report in March showcasing prescription spending and coverage for 2016.

Express Scripts reported that spending on prescription drugs in 2016 increased 3.8% per person for those that receive their coverage, 26.9 percent less than the 5.2 percent increase the prior year.

Furthermore, Express Scripts reported that for those who received their coverage specialty drug spending increased only 13.3 percent in 2016 compared to 17.8 in 2015, which was the lowest trend in 14 years.

The report also listed the 15 most expensive traditional and specialty drugs, ranked by a metric called per-member-per-year spend.

Treatments for inflammatory diseases like psoriatic arthritis and ankylosing spondylitis, occupied the top spot, with spending for these drugs rising 26.4 percent, and average cost per prescription in this class coming in at $3,587.83. According to the report, one of every five dollars spent on prescription drugs in 2016 was for a diabetes or a specialty inflammatory conditions drug.

Humira and Enbrel own about 70 percent of this market share. There are biosimilars available for both drugs, but Express Scripts noted these alternatives provided limited cost savings. Future predictions for this treatment area indicate an estimated 30 percent rise each year for the next three years, since a number of patent-related disputes could hinder widespread adoption.

Diabetes was the second-most expensive therapy class, according to the report, with insulins like Lantus and metformin capturing a little over 40 percent of this market share. Costs rose 19.4 percent in 2016 and the average cost per prescription for these therapies was $125.82.

Costs for these drugs could stay relatively stable for the next few years based on a continued increase in utilization of novel additive therapies for controlling blood sugar, like DPP-4 inhibitors and SGLT2 inhibitors.

Finally, oncology took the third spot as the most expensive therapy class, seeing a 19.4 percent increase with an average cost per prescription of $7,890.91. Celgene’s Revlimid, Genentech’s capacitabine, and Pfizer’s Ibrance are the top three drugs that own the most market share.

The report predicts oncology drug costs will continue to increase over 20 percent in each of the next three years due to patients using medications as maintenance therapies. Therewill also be an increasing prevalence in self-administered medications too.

Multiple sclerosis, pain/inflammation, HIV, high blood cholesterol, attention disorders, high blood pressure/heart disease, and asthma, also made the list of most expensive drug classes.

You can read the rest of the report here.