Spending on Specialty Medications Likely to Increase 67% through 2015

U.S. spending on specialty prescription drugs will increase 67% by the end of 2015, according to a forecast by Express Scripts. Specialty medicines are prescription drugs that require special handling, distribution, and administration. Many are biologics that are delivered via an injection or an infusion to treat chronic, complex diseases.

“The very high cost of these drugs creates difficult decisions for plan sponsors on which medicines to cover,” said Glen Stettin, M.D., of Express Scripts. By the end of 2015, drugs for cancer, multiple sclerosis, and inflammatory conditions, such as rheumatoid arthritis, will command higher drug spending than any other therapy class except diabetes .

Hepatitis C drug spending is expected to quadruple over the next three years, which is, by far, the largest percentage increase among therapy classes. The reason is that interferon-free medications are expected to gain FDA-approval in 2014. Also, new screening guidelines are expected to increase the number of people diagnosed with Hepatitis C.

Dr. Stettin said, “Plan sponsors can greatly improve the utilization trend and spending…by taking control of the pharmacy benefit.” A recent study demonstrated that payers who implemented Express Scripts’ cost management and patient care programs achieved 50% lower increases in specialty drug spending. Plan sponsors also saw higher medication adherence rates, which equates to better health outcomes and cost savings. Hepatitis C patients who received specialized clinical care from Express Scripts’ specialty pharmacy were 60% more likely to achieve an optimal adherence level, which leads to medical savings by curing the patient and avoiding further disease progression.

Also, safe, effective, and less-costly alternatives could become available once patents expire on marketed biologics. The country would save $250 billion from 2014 to 2024 if the 11 most likely biosimilar candidates were launched, according to Express Scripts.

Spending on traditional prescription drugs to treat common conditions will decline 4% by the end of 2015, largely because of the availability of generic medications. Only two of the top 10 traditional therapy classes, diabetes and attention disorders, are likely to see spending increases over the next three years, but those increases will be significant. Despite the availability of generic equivalents for many attention disorder therapies, spending is expected to increase 25% over the next three years due to higher utilization among middle-aged adults as well as wide geographic variation in diagnosis. Also, diabetes-medication spending is expected to rise 24% because of high prevalence and new therapies. For more information, visit www.express-scripts.com.

Last Updated 05/25/2022

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