Stay up-to-date on pharmacy benefit trends and payor solutions. Our job is to be the best manager of our clients’ pharmacy benefit by eliminating wasteful spend, reducing inefficient spend, and encouraging impactful spend that can help reduce medical costs. Gastronintestinal disorders: In 2020, trend could be influenced by small numbers of very costly non-alcoholic steatohepatitis drugs, including obeticholic acid and elafibranor. Formulary and utilization management (UM) strategies remain the foundation of effective pharmacy benefit management. For specialty drugs, higher utilization—not drug costs—was again the biggest factor driving specialty spending growth. That's on top of lower utilization due to concerns around opioid abuse. This list is not an all-inclusive specialty drug list. At some plan sponsors, total drug spending even declined. 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.” We’re personalizing health services to help people live healthier lives through breakthrough solutions like these: Patient Assurance ProgramSM ensures that every person living with diabetes who needs insulin pays no more than $25 per 30-day supply – even for brands that cost hundreds of dollars per prescription. 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. 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. Magellan projects that double-digit specialty drug cost growth will continue through 2020 but will be slower than the growth seen in 2018 and 2019. © 2021 Evernorth Health Inc. All Rights Reserved. Percent of total pharmacy costs paid by patients and plans, 2019. While private drug plans spent more on specialty medications in 2019, that amount was lower than 2018’s 6.9 per cent increase. Embarc Benefit ProtectionSM makes the costliest therapies, including gene therapy, more affordable for the patients who need them and the plans that cover them. Specialty treatments now comprise nearly half of all pharmacy spending and remain the key management challenge. While private drug plans spent more on specialty medications in 2019, that amount was lower than 2018’s 6.9 per cent increase. 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. 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. Multiple sclerosis: During 2020, top drugs such as Gilenya® (fingolimod), Tecfidera® (dimethyl fumarate) and Ocrevus® (ocrelizumab) will face competition, causing declines in unit cost that could spill over into 2021. Digital Health Formulary helps patients take better control of their health and eliminates the burden of evaluating thousands of digital health solutions on the market. 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. By 2016, 3 out of every 5 new drugs approved by the Food and Drug Administration (FDA) will be specialty drugs. The use of specialty medicines grew by 5%, more than twice the rate of other drugs, and now represents 2.2% of volume. Actual results may vary depending on benefit plan design, member demographics, programs implemented by the plan and other factors. To complement that broader ranking, we present below our exclusive list of the top 15 pharmacies based on specialty drug dispensing revenues. We use cookies and similar technologies to understand how you use our site and to create more valuable experiences for you. 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. Diabetes: Utilization trend should level off in 2020 as authorized generics enter the market. In 2018, specialty accounted for 45 percent of our clients’ pharmacy benefit spend. Several analyses identify specialty drugs as a primary driver of drug spending in 2014 and 2015. Trend for participating/nonparticipating plans in SafeGuardRx programs by therapy class, 2019. In the world of pharmacy, 49 drugs entered the market,1 including the gene therapy Zolgensma®, the most expensive single-dose drug ever, with a list price of $2.1 million! Percent of total drug spend by drug type, 2019. Trend forecast: What could drive drug spending for the next 3 years? Spending on specialty drugs is concentrated in mail-order pharmacies, retail pharmacies, clinics, and nonfederal hospitals. This page contains trademarks or registered trademarks of CVS Pharmacy, Inc. and/or one of its affiliates. Gross cost does not exclude member cost share, and it is net of rebates adjusted for other pharmaceutical reimbursements. In Medicaid that spend doubled from $4.8 to $9.9 billion over the same period. . 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. TRADITIONAL SPEND FOR 2018 AND 2019 A slow but steady increase in overall private drug plan spending continued in 2019. Specialty drugs may have one or more of the following qualities: frequent dosing adjustments, intensive clinical monitoring, intensive patient training and compliance assistance, limited distribution, and specialized handling or administration. Specialty medications include injectable and non-injectable drugs typically used to treat chronic, complex conditions. Spending rose by less than 3% in 2019, continuing a multiyear trend of slow growth. DRUG TREND & UTILIZATION SPECIALTY vs. Employers’ most daunting challenge and uncertainty when it comes to dealing with pharmacy spending is the specialty drug impact — specifically, new million-dollar therapies getting approved by the FDA. In Medicare Part D, net spending on specialty drugs rose from $8.7 billion in 2010 to $32.8 billion in 2015. 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 … the need to use a "specialty" pharmacy to determine if your medicine is covered by insurance; and the confusion grows. “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. This statistic shows the global pharmaceutical R&D spending from 2010-2024 in billion U.S. dollars. In 2019, specialty drugs accounted for 48.5 percent of net cost in Medicaid while making up just 1.3 percent of utilization. Although specialty drugs are used by only 2% of the population, its share of spend jumped from 44.7% in 2018 to 47.7% in 2019, nearly half of all spending on prescription drugs. Specialty pharmacy medications are dispensed in a retail, mail, or specialty pharmacy, typically self-administered by the patient, and covered under the pharmacy benefit. Client-specific modeling available upon request. But drugs are expensive, and it seems to be getting worse. Employers spent $83.9 billion on prescription drugs in 2016. At CVS Health, we share a clear purpose: helping people on their path to better health. Specialty drugs currently represent 39% of the overall pharmacy benefit spend, but the authors project that specialty drug costs will grow to 48% by 2020. MRx Pipeline is a quarterly report offering clinical insights and competitive intelligence on anticipated specialty and traditional drugs in the pipeline. Our strategies enabled clients to ensure appropriate use and mitigate the impact of high-cost drugs that do not demonstrate a clear clinical benefit. Specialty drugs made up only two per cent of drug claims in 2018, but 33 per cent of drug spending, the report found. Looking ahead to the next decade, Express Scripts remains committed to delivering care that’s simpler and more affordable for patients and payers. 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. 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. As specialty drugs grow in importance, they’re also becoming harder to obtain. Express Scripts Holding Co., one of the largest pharmacy benefit managers (PBMs) in the U.S., found last year that, among its plan members who had annual drug spend of at least $50,000, about 96% took specialty medicines. Intro: There are several publications on the Food and Drug Administration’s (FDA) activities over time, but specific information on specialty drug approvals and trends since 1990 are difficult to find. U.S. Food and Drug Administration. Tell us your role for customized content. In 2021 and 2022, unit cost trend could stabilize but negative overall trend should continue. 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. We estimate that in 2019, retail, mail, long-term care, and specialty pharmacies dispensed about $161 billion in specialty pharmaceuticals. Specialty Pharmacy Drug List January 2021 This list represents brand-name products in CAPS and generic products in lowercase italics. 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. 3 Express Scripts. 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. 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. 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. Express Scripts Pharmacy Increases Adherence and Savings, 2021 Medicare Star Ratings: By the Numbers. Low-spending scenario: Spending remains dampened in 2021. 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. Drug trend for commercial plans managed by Express Scripts, 2017-2019. Do you have questions about your plan’s drug trend? After that, two more brands are expected to gain FDA approval, driving unit cost trend up in 2022 as utilization steadily increases. Wednesday, March 27, 2019. A new Congressional Budget Office report Prices for and Spending on Specialty Drugs in Medicare Part D and Medicaid finds that net spending on specialty drugs to treat chronic, complex and rare conditions in Medicare Part D rose from $8.7 billion in 2010 to $32.8 billion in 2015. Patients taking a specialty drug often rely on enhanced clinical services to ensure safe use of the drug and optimize therapeutic outcomes. Industry-first solutions to help people live healthier lives, >> Download Executive Summary and Public Policy Analysis. 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 Drug Spending Grows While Traditional Medicine Spending Drops. Our overall purpose for this blog is to review the history of approvals and trends since 1990 for specialty medically covered drug. Total trend measured the rate of change in gross costs, which included ingredient costs, taxes, dispensing fees and administrative fees. Ten drugs accounted for $14.8 billion of that spend. 2018-04-26 14:11:00. Total trend could rise slightly, reflecting higher drug prices, as insulins are considered biologics from March 2020. 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. Because of higher prices and increased use, spending on specialty drugs also represents an increasing share of total health care costs, the Pew report notes, adding that in 2015, specialty drug spending reached $121 billion on a net price basis.By 2018, specialty drugs are expected to reach half of the total drug spend in the United States. 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.

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