Despite the continued rapid uptake in specialty and biologic drugs, overall drug spending across commercial, Medicare, and Medicaid managed care plans increased just 2.7 percent last year over 2011.* The effect of specialty drug costs was mitigated by the first decrease in traditional drug spending in more than 20 years, according to Express Scripts.
The traditional-drug spending trend was driven by higher generic-drug utilization, thanks to the arrival of the patent cliff. As managed care plans provided members with incentives to switch from brand-name pharmaceuticals to generic alternatives, utilization for 8 of the top 10 traditional therapy classes actually increased. Unit-cost decreases in 7 of those classes, however, more than compensated for the demand.
Specialty drugs continue to be a different story. Specialty-drug spending increased more than 18 percent over 2011, the strongest increase since 2004. Hepatitis C, respiratory, and cancer drugs led the way, each with spending increases of more than 25 percent. Biologics for inflammatory conditions represented the highest per-member, per-year spend — $50.62.
*Based on Express Scripts’ book of business. Express Scripts is the largest PBM in the United States.
Sources: Medco Drug Trend Reports 2009, 2010, 2011. Express Scripts Drug Trend Reports, 2012, 2013.
— Michael D. Dalzell