Specialty medicines have accelerated to the head of the pack to drive all spending growth in developed markets as non-specialty medication spending declines. Opioid utilization for those plans dropped 15.2% in 2019, on top of reductions of 16.6% in 2018 and 10.3% in 2017. 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.” 3. I… Specialty treatments now comprise nearly half of all pharmacy spending and remain the key management challenge. the need to use a "specialty" pharmacy to determine if your medicine is covered by insurance; and the confusion grows. 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. Despite these factors, with focused management, we helped our clients keep specialty trend in the single digits. 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. Keeping prescriptions affordable for plan members continues to be a key priority. 3 Express Scripts. 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. Dive Insight: The report underscores the dramatic effects specialty drugs are having on the healthcare system. Ten drugs accounted for $14.8 billion of that spend. © 2021 Evernorth Health Inc. All Rights Reserved. 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. Download your copy today! 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. “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. Both traditional and specialty drugs are included within each therapy class. Express Scripts prescription price index, 2014-2019. Specialty drugs are expected to represent almost 50 percent of total prescription drug spending in 2020. Between 2020 and 2027, retail drug spending under private health plans is projected to increase at an annual rate of 3% to 6%; besides the slow growth of the US biosimilar market, the report cited new costly therapies, mainly specialty drugs, as well as a drop-off in the impact of lower-cost generics. In 2021 and 2022, unit cost trend could stabilize but negative overall trend should continue. 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 … 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). 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.