Every year several of the largest pharmacy benefit managers put out reports on drug cost and utilization trends from the prior year. The Express Scripts report for 2013 is out. (Express Scripts Report) Overall commercial health plan drug trend was 5.4%, an increase of about 2% from the prior year and the first significant growth in drug trend in several years. Although specialty spending continues to grow quickly, at a 14.1% trend, it was a return to a positive trend for the more widely used traditional drug category that drove overall spending upward. For commercial health insureds, the average per person per year cost in 2013 was $868, with about 27.7% coming from specialty drugs. The bulk of the spending increase for both specialty and traditional drugs came from unit cost growth, not utilization. For Medicare, the per person per year spend is $2542, with around 24% being specialty. Traditional drug utilization rose, while specialty fell, but unit costs for traditional drugs decreased 3.7% while those for specialty went up by over 15%. Finally, for Medicaid the per person per year spend was $652, with specialty again being the fast growing category. Among common drug categories, diabetes medication trend was 14%, largely due to unit cost increases; lipid-lowering was down 14%, due to both unit cost and utilization declines; high blood pressure was down by 8.7%, due to unit cost reductions; and asthma was down by about 14%, again due to unit cost declines. These largely reflect continued generic substitution. Several specialty classes showed growth over 15%, with CNS disorders up 39%, cancer up 24% and anti-inflammatory drugs up 22%. Looking forward, the report warns of continuing high growth in specialty drug spending, as much as 63% between 2014 and 2016, while traditional drug trend is anticipated to be around 2% each year.
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The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected].
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