For a number of years prescription drug spending was an outsized contributor to overall health costs, but that growth has ameliorated in recent years. But subsectors like specialty drugs are still seeing rapid increases. The current Express Scripts Drug Trend Report gives a wealth of information on where one of the largest PBMs, now owned by Cigna, sees medication use and spending heading. (Express Scripts Report) For its commercial plans, those primarily operated for employer-sponsored coverage, in 2018 spending rose a mere .4%, composed of a .4% decline in unit cost and a .8% rise due to utilization. Express Scripts says 50% of its customers had negative trend and it saved clients $45 billion. Within this, however, specialty is very problematic, with a 7.3% utilization increase coupled with a 2.1% unit cost rise leading to 9.4% greater specialty medication spending. Specialty is almost 45% of all spending at this point, up from 41% in 2017. Patients were responsible for 15% of all commercial plan drug spend, stable with prior years.
On the Medicare side, overall trend was .3%, but specialty was again an issue, with a 6.4% utilization increase and 2.4% unit cost growth leading to 8.8% spending growth. Express Scripts also claimed that it saw significant reductions in opioid use, with a focus on limiting the number of days supply. Insulin medication has experienced rapid price increases, but Express Scripts also says it was able to limit the impact of those by steering people to more cost-effective versions. Some drug categories with higher trend include inflammatory conditions, oncology and HIV, all of which have heavy use of specialty compounds and see frequent introduction of new compounds. Categories with lower trend included cholesterol-lowering drugs, blood pressure meds and pain drugs, with the first two being largely due to use of generics. Oncology drugs are also a significant contributor to higher spending for Medicare, as are blood-thinning medications. The report suggests good and bad news. Overall, health plans and their vendors have been able to control drug spending much better than in past years. But warning signs continue to flash on specialty costs, particularly as that category becomes a greater proportion of all spending.