Express Scripts is one of the three largest PBMs and is now currently owned by Cigna, the large health insurer. We get a somewhat abbreviated version of their annual drug trend report this year, covering 2019. (ESI Report) Don’t know if the new owner is a cheapskate or what, but this year’s publicly available version is largely nothing but a marketing piece, with less useful information than in past years. According to the firm, its commercial plans had a 2.3% drug spending rise in 2019, comprised of 1.4% utilization growth and .9% unit cost rises. For Medicare the utilization growth was .2% and unit price rises were 1%, for total trend of 1.2%. For Medicaid, total trend was 6.9%, comprised of 4% utilization increases and 2.9% unit price growth. Bad news for the states, who fund a lot of Medicaid costs. The trend was lowered to 1.2% for commercial customers using at least one of the company’s “value-based” programs, and declined by 4.8% for those using at least three. $49.5 billion in savings was supposedly generated for customers. ESI also noted a number of reductions in ER visits and other benefits of its pharmacy management programs.
Brand drug prices apparently rose 5.2%. From 2014 to 2019 they increased a total of 70%, while the general CPI was only going up about 10% and generic drug prices declined about 40%. Specialty drugs, which are almost all branded, accounted for 47.7% of all spending, up from 44.7% last year, even though only 2% of the population uses such a medication. Average out-of-pocket cost for a 30 day prescription was $11.75, up 1.6%. Plans paid 85% of all drug costs and patients paid 15%. The top categories for spending were diabetes, inflammatory conditions, oncology, psychiatric and neurologic drugs, HIV and asthma. For those customers participating in the value-based programs, the trend for inflammatory drugs was 15.5%, for oncology it was 11.2%, for multiple sclerosis it was 9% and for asthma 12.1%. Since oncology and inflammatory drugs are two of the most expensive categories, that isn’t particularly good. But in general, it appears that the line is being held on keeping total drug spending from achieving the kind of year-over-year increases we were seeing a decade ago.