High-Spending Medication Users

Overall drug spending has re-accelerated in the last couple of years.  But the distribution of spending is very skewed, with a few patients incurring very high medication costs, as revealed in a new Express Scripts report.   (ESI Report)   In 2014, a staggering 576,000 Americans had prescription costs of over $50,000, up 63% from the prior year.  And 139,000 had costs over $100,000, a rise of 193% from 2013.  Patients with expenses over $50,000 account for almost 16% of all drug spending.  The only good news for patients is that health plans are bearing about 98% of those very high costs.  That, however, likely drives up premiums for everyone.

For the group having $100,000 or more in expenses, 60% are taking more than 10 prescription drugs, 33% are being treated for 10 or more medical conditions, 90% are using at least one specialty medication, 32% are taking a cancer drug and 30% are using a compounded medication, which have skyrocketed in price.  And, understandably, with all these problems and spending, they have much higher rates of use of anti-depressants.  Men aged 50-70 are the most likely patients to be in this very high-cost category.  The new hepatitis C drugs are one driver of this high spending, but other diseases, like cancer are prime contributors.  The growth in compounded medication use is a clear opportunity for utilization control, since there are usually non-compounded alternatives which, while they don’t allow the pharmacies to make as much money, provide equal outcomes for patients.  As with all health spending, concentrating on a few high drug-spending patients likely gives the greatest return.