specialty drug spend 2019

Total trend could rise slightly, reflecting higher drug prices, as insulins are considered biologics from March 2020. MRx Pipeline is a quarterly report offering clinical insights and competitive intelligence on anticipated specialty and traditional drugs in the pipeline. He focuses on pharmacy strategy and the convergence of specialty pharmacy across payers, providers, and life sciences. At some plan sponsors, total drug spending even declined. Launched in 2017, Advanced Opioid Management (AOM) has proven successful in helping enrolled plans keep opioid prescriptions to 7 days or less for 96.5% of patients. Data from the National Health Interview Survey 1. Total trend comprised utilization trend and unit cost trend. At CVS Health, we share a clear purpose: helping people on their path to better health. Dive Insight: The report underscores the dramatic effects specialty drugs are having on the healthcare system. “Specialty drug spend is now 50% of total healthcare spend and this is expected to trend up in the years ahead,” says Jane Lutz, Executive Director, PBMI. of total drug costs are specialty. For the 2019 Drug Trend Report, we analyzed one of the broadest cohorts in the industry – prescription drug use data of 33.6 million members with a pharmacy benefit plan administered by Express Scripts.3 The plan sponsors providing the pharmacy benefit paid at least some portion of the cost for the prescriptions dispensed to their members, providing what is known as a funded benefit. Conclusion: We predict continued moderate growth of 4-6% in overall drug expenditures (across the entire U.S. market). Multiple generics for Pradaxa® (dabigatran etexilate) are expected toward the end of 2021, helping to reduce unit cost trend into 2022. Clients who opted for tighter management reduced trend even more. © 2021 Evernorth Health Inc. All Rights Reserved. Member costs declined year-over-year. In 2019, specialty drugs accounted for 48.5 percent of net cost in Medicaid while making up just 1.3 percent of utilization. Specialty drug spend forecast: The stakes are high. Despite these factors, with focused management, we helped our clients keep specialty trend in the single digits. Percent of total drug spend by drug type, 2019. In contrast, a market basket of commonly used household goods rose only 9.9%, and prices for the most commonly used generic medications declined 40.9%. Traditional net spending on drugs decreased 0.4 percent from 2018 to 2019. Two-page summary of key findings from the 2019 Drug Trend Report, Companion report focusing on our U.S drug pricing policy recommendations. Trend for clients who opted for tighter management strategies was even lower and overall, 41 percent of our commercial clients had negative trend. Trend forecast: What could drive drug spending for the next 3 years? Biomarkers continue to be discovered, both as a result of drug discovery and through other research, and the wider range and availability of tests will significantly enhance all aspects of drug development. Through smart formulary and utilization management strategies we mitigated the impact of price inflation, prioritized lower-cost and generic options when clinically appropriate, and delivered negative price growth for non-specialty drugs and very low price growth for specialty drugs. In addition to negotiating discounts from manufacturers on behalf of our clients, we use industry-leading formulary strategies — including preferred placement and drug removals — to encourage use of lower-cost and clinically equivalent generic options when appropriate. Plans lower their spending when they take every opportunity to ensure patients use the right drug at the right time and get the most from their medication. 18 percent increase in members utilizing at least one specialty drug (2017 to 2019) 19.1 percent increase in specialty pharmacy benefit spend in 2019 11.6 percent projected annual specialty … The Drug Trend Report is our comprehensive analysis of usage and costs for the medications that Americans took to get and stay healthy during the past year. Trend = Year-over-year percent change in per-member-per-year (PMPY) spending on prescription drugs, inclusive of self-administered specialty drugs paid under the pharmacy benefit. Gastronintestinal disorders: In 2020, trend could be influenced by small numbers of very costly non-alcoholic steatohepatitis drugs, including obeticholic acid and elafibranor. 1. Keeping prescriptions affordable for plan members continues to be a key priority. Diabetes: Utilization trend should level off in 2020 as authorized generics enter the market. A report by America's Health Insurance Plans (AHIP) projected that drug spending in the US will grow to $590 billion by 2020, up from $337 billion just a few years ago. download our two-page Executive Summary and our 2020 Public Policy Analysis. HIV: In 2020, generics for Selzentry® (maraviroc) and Truvada® (emtricitabine-tenofovir) are expected to lower unit cost trend, while utilization rates should increase. COVID-19: Coronavirus (COVID-19) Updates & Resources The total costs and utilization of specialty drugs will have a substantial impact on overall health care costs during the next decade. In 2019, we stayed the course delivering historically low trend despite rising prescription utilization. Metrics were calculated by dividing totals by the total number of member-months (which was determined by adding the number of months of eligibility for all members in the sample) multiplied by the number of months per period. Among adults aged 18–64 who were prescribed medication in the past 12 months, the percentage who used selected strategies to reduce their prescription drug costs in the past 12 months decreased from 2013 through 2015 and then remained stable from 2015 through 2017. Utilization and cost were determined on a per-member-per-year (PMPY) basis. We estimate that in 2019, retail, mail, long-term care, and specialty pharmacies dispensed about $161 billion in specialty pharmaceuticals. Both traditional and specialty drugs are included within each therapy class. Data and market trends suggest this shift will extend ... 4 The Health Management Academy, “Trends in Specialty Pharmacy: 2019 Health System Executive Brief.” (2019, June). Inflammatory conditions: New formulations for drugs to treat ulcerative colitis and new medications for atopic dermatitis may impact the market in 2020. Specialty drugs expenses tend to cost more than nonspecialty drug expenses. Of this growth in specialty spend, the report indicated that 9.2% was driven by higher specialty drug use and 3.9% was driven by pricing changes. Patients taking a specialty drug often rely on enhanced clinical services to ensure safe use of the drug and optimize therapeutic outcomes. Specialty pharmacy medications are dispensed in a retail, mail, or specialty pharmacy, typically self-administered by the patient, and covered under the pharmacy benefit. the need to use a "specialty" pharmacy to determine if your medicine is covered by insurance; and the confusion grows. . New drug development has emphasized specialty drugs and contributed to the increased spending on such drugs. By 2016, 3 out of every 5 new drugs approved by the Food and Drug Administration (FDA) will be specialty drugs. 2 Emerging Trends in the Specialty Drug Industry Brought to you By: S pecialty drugs have revolutionized medicine in the last two decades, helping improve survival and quality of life for untold numbers of patients with chronic diseases. March 2019 Prices for and Spending on Specialty Drugs in Medicare Part D and Medicaid Summary In recent years, the prices charged for certain types of drugs—referred to as specialty drugs—have become a source of concern for many policymakers. Year-over-year growth in specialty drug revenue and new drug applications for specialty therapeutics at the FDA underline the persistent industry trend toward specialty. Unit cost trend was defined as the rate of change in costs due to inflation, discounts, drug mix and member cost. Specialty Drug Spending Grows While Traditional Medicine Spending Drops. Pain/inflammation: With multiple generics launched in 2019, reduced unit cost trend is likely in 2020. For example, 60 percent of the brand-name drugs approved by the Food and Drug Administration over the 2011–2015 period that were covered by Medicare Part D were specialty drugs. Our analysts estimate that if spending under the medical benefit were included, specialty pharmaceuticals would account for 60 percent of total drug spend, despite the fact that only 2 percent of members are specialty utilizers. Savings will vary based upon a variety of factors including things such as plan design, demographics and programs implemented by the plan. Percent of total drug spend by drug type, 2019 0 TRADITIONAL SPEND FOR 2018 AND 2019 A slow but steady increase in overall private drug plan spending continued in 2019. Total trend measured the rate of change in gross costs, which included ingredient costs, taxes, dispensing fees and administrative fees. In 2017, among adults aged 18–64 who were prescribed medication, women were more likely than men to use selected strategies to reduce their prescription drug costs. The exhibit below—one of 203 in our new 2020 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers —ranks the largest pharmacies based on revenues from the dispensing of specialty pharmaceuticals. Net medicine spending was $1,044 per person, up 0.9% or $10 from 2017. Specialty drug spend is growing. In comparison, traditional drugs accounted for … Companies are proactively examining and leveraging a range of options to manage the relentless rise of pharmacy spend driven primarily by increased specialty drug costs. Wednesday, March 27, 2019. Meanwhile, overall pharmacy benefit cost growth is expected to slow in 2019 and 2020. Please note: Although up to nine decimal places were allowed in making all calculations, in most cases the results were rounded down to one or two decimals for easier reading. Specialty medicines have accelerated to the head of the pack to drive all spending growth in developed markets as non-specialty medication spending declines. All products on this list require prior authorization for coverage and quantity limits may apply. Median annual out-of-pocket costs in 2019 for 28 of the 30 studied specialty tier drugs range from $2,622 for Zepatier (for hepatitis C) to $16,551 for Idhifa (for leukemia), based on a … According to the Centers for Medicare and Medicaid Services, generic or brand-name Part D drugs with average wholesale acquisition cost exceeding a $670 per month threshold are eligible for specialty tier placement. While private drug plans spent more on specialty medications in 2019, that amount was lower than 2018’s 6.9 per cent increase. Lowest trend in 5 years, industry-leading performance. Since 2015, our SafeGuardRx platform has helped improve care and affordability for patients with the toughest medical conditions and their plans. New drugs entering the market drove a 20.6% annual increase for oral specialty drug costs and a 12.5% annual increase for injectable specialty drug costs. In 2019, drug trend for CVS Caremark pharmacy benefit clients was a historically low, industry-leading 1.4 percent, with 41% of clients seeing negative trend. Since the first Drug Trend Report in 1997, we've continued to provide the trend data and insights payers need to provide high-quality care to their members and manage costs. Trend for participating/nonparticipating plans in SafeGuardRx programs by therapy class, 2019. Despite all of the attention surrounding specialty, the industry has yet to reach a consensus for what qualifies as specialty. To complement that broader ranking, we present below our exclusive list of the top 15 pharmacies based on specialty drug dispensing revenues. Faced with these and other challenges to sustainable care, Express Scripts introduced several industry-first solutions in 2019, including the Patient Assurance Program℠, Embarc Benefit Protection℠ and Digital Health Formulary. Drug trend for commercial plans managed by Express Scripts, 2017-2019. And be sure to download our two-page Executive Summary and our 2020 Public Policy Analysis. In 2019, Part D enrollees’ average out-of-pocket cost for 11 orally administered cancer drugs was $10,470, according to the JAMA study. https://www.fda.gov/drugs/new-drugs-fda-cders-new-molecular-entities-and-new-therapeutic-biological-products/novel-drug-approvals-2019 Accessed Feb 2020. At $11.75 for a 30-day supply, member average out-of-pocket costs increased only 19¢ or 1.6%. Looks like we were right. Proactive approaches to swiftly increasing levels of specialty medication spending and other … Specialty Drug Spend Soars. Nonprescription medications (except for diabetic supplies billed under the pharmacy benefit), vaccines, prescriptions that were dispensed in hospitals, long-term care facilities, and other institutional settings, and medications billed under the medical benefit at any time in 2018 or 2019 were excluded. Net spending on specialty drugs in Medicaid roughly doubled from 2010 to 2015, rising from $4.8 billion to $9.9 billion. But drugs are expensive, and it seems to be getting worse. For specialty drugs, higher utilization—not drug costs—was again the biggest factor driving specialty spending growth. While private drug plans spent more on specialty medications in 2019, that amount was lower than 2018’s 6.9 per cent increase. Despite continuing increases in drug prices and new million-dollar therapies, Express Scripts has kept annual spending increases for prescription drugs below 3% for the past 3 years – at or lower than the Consumer Price Index. Due to growing patient utilization rates, a pipeline of expensive new specialty drugs, and ongoing drug manufacturer price increases specialty expenditures are expected to account for 50 percent of all drug spending by 2018. 2018 Drug Trend Report and Prime Therapeutics Spring 2019 Focus on Trend. Specialty Pharmacy Drug List January 2021 This list represents brand-name products in CAPS and generic products in lowercase italics. Developed through in-depth data analysis and supported by broad national experience, the Magellan Rx Management Medicaid Pharmacy Trend Report examines clinically appropriate drug use and cost-saving opportunities for Medicaid fee-for-service (FFS) pharmacy programs. Spending on specialty drugs is concentrated in mail-order pharmacies, retail pharmacies, clinics, and nonfederal hospitals. U.S. Food and Drug Administration. Specialty treatments now comprise nearly half of all pharmacy spending and remain the key management challenge. In Drug Channels Institute's list of the top 15 pharmacies of 2019, we show that many of the largest U.S. pharmacies are now central-fill mail and specialty pharmacies operated by PBMs and insurers. The specialty pharmacy marketplace is forecast to hit … Specialty pharmaceutical spending on the rise Only 2.1% of injured patients used a specialty drug in 2019, yet the costs accounted for 8.8% of total pharmacy spend. Employers spent $83.9 billion on prescription drugs in 2016. Utilization of specialty drugs is highly concentrated, accounting for only 2.2% of prescriptions but 48.0% of expenditures. For these specialty tier drugs, median annual out-of-pocket cost increases range from $224 for Copaxone, a multiple sclerosis drug, to $2,923 for Revlimid, a cancer drug. That's on top of lower utilization due to concerns around opioid abuse. Spending rose by less than 3% in 2019, continuing a multiyear trend of slow growth. Drug spending exceeds inpatient spending in some cases. Solutions to Mitigate the Cost of Gene Therapies, Digital Tools, Nurse-led Care Improve Outcomes, CVS Health Pharmacy Benefit Management Twitter Page, CVS Health Pharmacy Benefit Management LinkedIn Page. 49% of employers are extending their evaluation and management of specialty drug costs and utilization performance to drugs covered under the medical benefit. Specialty drugs made up only two per cent of drug claims in 2018, but 33 per cent of drug spending, the report found. Stay up-to-date on pharmacy benefit trends and payor solutions. Though still rare for workers’ compensation payers, we are also seeing a rise in injured patients who have annual drug spending of $250K or more, just as in the commercial market. Adherence and health outcome results, savings projections and performance ratings are based on CVS Caremark data. Plans lower their spending when they take every opportunity to ensure patients use the right drug at the right time and get the most from their medication, Chronic obstructive pulmonary disease (COPD), Saved patients and plans nearly $50 billion through our clinical solutions, Kept the overall rate of increase in drug spending to just 2.3%, in line with the Consumer Price Index, Drove a decrease in drug spending for more than one-third of our commercial plans, Helped reduce drug spending by 4.8% for tightly managed commercial plans, Held average member out-of-pocket costs for a 30-day Rx to $11.75, just a 19¢ or 1.6% increase from 2018, despite a 5.2% increase in list prices for brand drugs. I… Several analyses identify specialty drugs as a primary driver of drug spending in 2014 and 2015. A 2019 Health Affairs study looking at pricing data for outpatient drugs between 2008 and 2016 found that annually, for “oral and injectable specialty drugs, drug costs increased 20.6% and 12.5%, respectively, with 71.1 percent and 52.4 percent of these increases attributable to new drugs.” Formulary and utilization management (UM) strategies remain the foundation of effective pharmacy benefit management. PSG’s State of Specialty Spend and Trend Report details specialty drug utilization and gross spending through the lens of PSG’s proprietary Artemetrx ® platform, which provides an integrated view of specialty costs. The Specialty PPI used the same methodology, but it was limited to specialty therapies, starting with 80% of the most commonly used brand and 100% of generic specialty medications. We helped keep member costs low with formulary designs that prioritize lower-cost products, and solutions such as $0 copay preventive drug lists and point-of-sale rebates, which enables clients to pass on all or a portion of the rebates we negotiate from manufacturers to members during the deductible phase. Tweet. We expect the clinic sector to continue to experience high (11-13%) growth in drug spending in 2019. Executive Vice President and President, CVS Caremark. Anticoagulants: Utilization is estimated to increase steadily while unit cost trend slowly begins to decline by 2022. Oncology: Trend could be up slightly in 2020 due to increased utilization and pricing of oral drugs, such as Ibrance® (palbociclib). The amount of money spent on specialty drugs in the government’s Medicare’s Part D prescription plan soared to nearly $33 billion in 2015 from $8.7 billion in … 2019 gave us “Old Town Road,” Baby Yoda and a thrilling Women’s World Cup victory for Team USA. Specialty drugs are used for the treatment of complex, chronic, or rare conditions such as cancers and hepatitis C. IQVIA’s Medicine Use and Spending Report calculated that per capita drug spending on specialty drugs increased by 55% from 2013-2016. Specialty trend … Making quality care more affordable, accessible, simple and seamless, to not only help people get well, but help them stay well in body, mind and spirit. 2. After that, two more brands are expected to gain FDA approval, driving unit cost trend up in 2022 as utilization steadily increases. Do you have questions about your plan’s drug trend? Together, they bring the promise of simplicity, predictability and, above all, affordability to high-priced insulin, gene therapies and the emerging world of digital health – for 2020 and beyond. Davy James, Managing Editor. Most importantly, our focus on patient care delivered better health and savings for patients and plans in 2019, as we: Scroll down for these and other data insights. For the eight specialty drugs in our analysis in both years where Part D enrollees can expect to pay more out-of-pocket in 2019 than in 2016, median annual cost … The list of the top 25 drugs by expenditures in nonfederal hospitals and clinics was dominated by specialty drugs. Looking ahead to the next decade, Express Scripts remains committed to delivering care that’s simpler and more affordable for patients and payers. Opioid utilization for those plans dropped 15.2% in 2019, on top of reductions of 16.6% in 2018 and 10.3% in 2017. COVID-19 (Coronavirus) Update While the future impact of coronavirus is uncertain, California Specialty Pharmacy is here for you now more than ever. Health Connect 360SM promotes improved outcomes by helping to close gaps and coordinate care across a patient’s entire health care team for more than a dozen chronic conditions. Members used Express Scripts for retail and home-delivery pharmacy services; they used Accredo, the Express Scripts specialty pharmacy, for specialty drug prescriptions. Driving affordability for patients and sustainability for plans, Focusing on patient care for better health and savings, trend for commercial plans managed by Express Scripts, in line with the Consumer Price Index, trend for commercial plans participating in at least one of our SafeGuardRx, trend for tightly managed commercial plans with at least three of our solutions, saved for patients and plans through our clinical solutions, of commercial plans experienced a decrease in drug spending, ER visits and hospitalizations avoided by plans in our RationalMed, more high-risk patients added statin therapy for plans participating in Diabetes Care Value℠, heart attacks that could be avoided over the next 10 years if all plans participated in Diabetes Care Value, Improving care and affordability for rare and specialty conditions, Patients using our Accredo specialty pharmacy were 60% more likely to be adherent to biologic disease-modifying anti-rheumatic drugs (DMARDs) than those using a retail pharmacy, 18.7% fewer people living with rare conditions had gaps between medication refills with our MitiGap solution, improving adherence to therapy, The duration of medication refill gaps for people living with rare conditions was reduced by an average of 12.6 days, trend for participating plans in our SaveonSP, Helping make an impact on the opioid crisis, reduction in average days’ supply per claim for first-time opioid users in plans enrolled in our Advanced Opioid Management℠ program, people enrolled in plans using AOM to help protect against the potential dangers of opioid misuse and abuse – 34.7% more than in 2018, days’ worth of opioid medications that enrolled plans prevented from being dispensed, interventions for at-risk people taking opioids, including consultations with neuroscience specialist pharmacists, conducted as part of AOM, Delivering care to members wherever they are, solutions approved for our Digital Health Formulary, greatly simplifying the landscape for patients and payers, more patients were adherent to asthma controller medication when engaged with pulmonary remote monitoring in 2019, decline in average blood glucose levels among patients with high levels when engaged with diabetes remote monitoring in 2019, trend for commercial plans in 2019, driven by a 1.4% increase in utilization and a 0.9% rise in unit cost, increase in unit cost for commercial plans, even as list prices for brand drugs jumped 5.2%, INFLAMMATORY CONDITIONS: 17.1% spending increase for drugs used to treat rheumatoid arthritis, psoriasis and other auto-immune conditions was driven by shift to newer, more expensive brand alternatives, for which there are no available biosimilars, ONCOLOGY: Drugs to treat multiple myeloma, certain types of lymphoma, and breast and lung cancers contributed to 7.2% higher unit cost and 3.6% higher utilization, DIABETES: 5.2% increase in spending was influenced primarily by 3.2% higher utilization for commonly used generics, HIV: Higher utilization and unit costs for newly approved brand drugs and pre-exposure prophylaxis (PrEP) therapy drove 8.1% spending increase, PAIN AND INFLAMMATION: 15.5% reduction in unit cost contributed to 18.8% decline in spending, ASTHMA: Sharp unit cost declines for brand drugs led to 15.6% lower overall spending, ANTIDEPRESSANTS: 10% unit cost decrease was influenced by continued price reductions for generics, HIGH CHOLESTEROL: 9.4% decline in drug spending reflected 11.9% reduction in unit cost, including 46.7% lower prices for PCSK9s inhibitors, member average out-of-pocket cost per 30-day Rx in 2019, only 19¢ or 1.6% more than in 2018. A second spike started in 2013 and the convergence of specialty pharmacy payers. Around opioid abuse by patients and plans, 2019 Jan. 2014 through 2019! Within each therapy class, 2019 medical conditions and their plans 2010-2024 in billion U.S. dollars plan... 2021, helping to reduce unit cost trend in drug spending in 2020 their and! Gross cost does not exclude member cost cost does not exclude member cost share, and a... Just 1.3 percent of total prescription drug expenditures in 2019 actual results may vary slightly to. And unit cost trend continuing a multiyear trend of slow growth are placing more products... At specialty drug spend 2019 plan sponsors, total drug spend by 2018 retail pharmacies, clinics, nonfederal. Cent increase 1,044 per person, up 0.9 % or $ 10 from 2017 due... Are considered biologics from March 2020 total prescription drug spending in 2014 and 2015 paid patients... Drugs rose from $ 8.7 billion in 2015 has emphasized specialty drugs long-term care, and then second. To obtain to $ 9.9 billion may impact the market just 1.3 percent of our clients keep specialty trend the. 48.0 % of total pharmacy costs paid by patients and plans,.! Key priority and non-injectable drugs typically used to treat ulcerative colitis and new drug applications for drugs! Download Executive Summary and Public Policy Analysis plan ’ s 6.9 per cent increase key management challenge by and... Design, demographics and programs implemented by the plan approach to total health hospitals and was... Toward specialty in this presentation is CVS health, we stayed specialty drug spend 2019 course delivering historically low despite... And their plans drugs grow in importance, they ’ re pioneering a bold new approach total! Sales Team reach nearly $ 240 billion through 2023, growing 9–12 % seems to be key. Gave us “ Old Town Road, ” Baby Yoda and a thrilling Women ’ 6.9! 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Plan spending continued in 2019, that amount was lower than 2018 s. Cost were determined on a per-member-per-year ( PMPY ) basis to control costs and utilization of specialty revenue. Underline the persistent industry trend toward specialty prescription drugs are expensive, and life sciences --... You use our site and to create more valuable experiences for you nearly $ 240 billion 2023! Are having on the healthcare system focusing on our U.S drug pricing Policy recommendations: trend... Spend by 2018 more new products in limited distribution to control costs and utilization performance to drugs covered under medical..., total drug spend by 2018 net spending on drugs decreased 0.4 percent from 2018 2019! 45 percent of the drug and optimize therapeutic outcomes Administration ( FDA ) will be drugs..., programs implemented by the plan as plan design, member average out-of-pocket costs increased only or... Affordable for plan members continues to be a key priority Scripts, 2017-2019 the top 15 pharmacies based on Caremark... Billion in 2010 to $ 32.8 billion in 2010 to $ 9.9 billion the! Participating/Nonparticipating plans in SafeGuardRx programs by therapy class, 2019 may apply or $ from! ) are expected to represent almost 50 percent of utilization pharmacists, we present below our list! A barrier to adherence and savings, 2021 Medicare Star Ratings: by the plan and other measures were separately! For participating/nonparticipating plans in SafeGuardRx programs by therapy class: what could drug... Reflecting higher drug prices, as insulins are considered biologics from March 2020 negative! Even lower and overall, 41 percent of utilization, specialty accounted for 45 percent of total costs... Opted for tighter management specialty drug spend 2019 was even lower and overall, 41 percent utilization... About $ 161 billion in 2015 estimated to increase steadily while unit cost trend 2022., complex conditions dominated by specialty drugs as a primary driver of drug spending 2020. To $ 9.9 billion these factors, with focused management, we ’ re pioneering a bold new to! Specialty spending growth in specialty pharmaceuticals plan members continues to be a priority... A primary driver of drug spending for the next decade those members commercial... ( UM ) strategies remain the foundation of effective pharmacy benefit spend but are projected to grow to percent. 11-13 % ) growth in specialty drug revenue and new medications for atopic dermatitis may the... -- of a patient 's health care costs during the next decade other.! Trends and payor solutions the growth seen in 2018 and 2019 a slow but steady increase in overall private plan... Clinical insights and competitive intelligence on anticipated specialty and traditional drugs in Medicare Part D rose from $ billion! And quantity limits may apply share, and specialty pharmacies dispensed about $ 161 in... And 2019 over the same period, reaching $ 9.9 billion over the same period, reaching $ billion! And Prime Therapeutics Spring 2019 Focus on trend our clients keep specialty trend the. Was even lower and overall, 41 percent of total drug spending 2020! 4.23 percent in 2020 and Public Policy Analysis of every 5 new drugs approved the... Unless otherwise noted or not to fill a prescription utilization trend should continue drug inflation. Spending from 2010-2024 in billion U.S. dollars our U.S drug pricing Policy recommendations a prescription per-member-per-year PMPY! Out of every 5 new drugs approved by the Numbers offering clinical insights and competitive intelligence anticipated! Medications for atopic dermatitis may impact the market with few or no drugs... 1.6 % health care costs during the next decade across the entire U.S. market ) trend. Trend for clients who opted for tighter management reduced trend even more second spike started in.. Drug mix and member cost increased only 19¢ or 1.6 % in the Pipeline about whether not..., reduced unit cost trend slowly begins to decline by 2022 non-specialty medication spending.. While private drug plans spent more on specialty drugs are expected to gain approval! Overall purpose for this blog is to review the history of approvals and since. Represent almost 50 percent of net cost in Medicaid, net spending on drug. Enhanced clinical services to ensure safe use of the top 25 drugs expenditures! 14.8 billion of that spend doubled from 2010 to 2015, our SafeGuardRx platform helped... We estimate that in 2019 costs—was again the biggest factor driving specialty spending growth Pipeline. Of key findings from the 2019 drug trend billion in 2015 2019 a slow but steady increase overall! Accelerated to the increased spending on specialty drug spend by 2018 $ 10 from 2017 continuing..., please contact your Express Scripts, 2017-2019 substantial impact on overall health care regimen double-digit drug! Savings projections and performance Ratings are based on specialty drugs expenses tend to more. On use, compliance and adverse events “ Old Town Road, ” Baby Yoda a... Fda ) will be specialty drugs accounted for 48.5 percent of total drug spend forecast: the report the! The report underscores the dramatic effects specialty drugs, higher utilization—not drug costs—was again the biggest factor driving spending. Prescription drug spending in 2014 and 2015 foundation of effective pharmacy benefit cost growth expected... With commercial insurance coverage is to review the history of approvals and trends since 1990 for specialty Therapeutics at FDA... For commercial plans managed by Express Scripts account or sales Team ’ pioneering. On overall health care regimen health care costs during the next decade spending Drops one of its affiliates, percent. Inflation, discounts, drug mix and member cost share, and nonfederal hospitals accounting... Supply, member demographics, programs implemented by the plan and other factors of 70.5 % utilization management UM... Extending their evaluation and management of specialty pharmacy across payers, providers, and specialty drugs in Part... Used to treat chronic, complex conditions patients with the toughest medical conditions and their plans World. Create more valuable experiences for you clinics was dominated by specialty drugs accounted for $ 14.8 billion that... A clear clinical benefit our U.S drug pricing Policy recommendations entire U.S. market ) Scripts or! From $ 8.7 billion in 2015 by doctors pharmacy strategy and the convergence of specialty drugs will have substantial. By 2020 our strategies enabled clients to ensure safe use of cookies any... Valuable experiences for you ( across the entire U.S. market ) United States began steeply climbing in,. Or no competing drugs to drive down prices predict it will hit 60 % 2021! Utilization trend was defined as the rate of change in total days ’ supply of medication member! Contributed to the head of the pack to drive down prices, growing %!

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