The war of words between drug manufacturers and PBMs on who is most responsible for high medication spending has put PBMs on the defensive. Annual drug trend reports are a good vehicle to try to demonstrate the efficacy of cost control measures. Express Scripts has released its report on 2017. (ESI Report) For commercial plans, overall per person trend was 1.5%, the lowest in 24 years of tracking. For traditional drugs, which are 60% of all spending, trend was a 4.3% decline, driven by a 4.9% decrease in unit costs. The generic fill rate was 86%. Things aren’t so rosy in specialty land, which now represents 40% of total drug spend. Those costs rose 11.3% per person, composed of an 8.1% utilization increase and 3.2% unit price growth. The unit price rise is well-controlled, potentially because of biosimilars, but the utilization uptick has to concern plans.
Medicare trend was 2.3% and Medicaid was 3.7%. For members through health insurance plans, drug costs actually decreased by 3.3%. Express Scripts highlighted its programs to lower costs for specific diseases and reported that plans adopting all these programs actually had a negative drug spend trend. The PBM also has a program to combat opioid dependence and indicated that the average days of drug per prescription declined by over 50%. Commercial members covered about 14.3% of total drug costs, consistent with the prior year. Those in high-deductible plans had 23.5% lower utilization, but still had average annual costs over 25% higher than did members in more traditional plans. Inflammatory conditions, diabetes, oncology and multiple sclerosis had the highest per member per month spend. Inflammatory conditions, oncology and HIV had trends well into the double digits.
Finally, the firm gave a positive forecast for the next three years, expecting very limited drug spending growth of only 1% to 3% a year. That would be good news for plans.