Express Scripts Report: Top Drug Classes Driving Spending Growth

Therapies for inflammatory conditions accounted for nearly half of spending among different drug classes for commercial drug plans in 2019, according to a new Express Scripts Drug Trend Report.

The report found that drugs for this therapeutic area drove 43.7% of spending, likely due to the shift toward newer, more expensive brand alternatives, with a 17.1% spending increase from 2018.

Specialty drug spend accounted for the greater share of total spend than in 2018. Specialty drug costs continue to inch toward nearly half of all spending on prescription drugs, increasing from 44.7% in 2018 to 47.7% in 2019, the report found.

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The analysis, which is released annually by pharmacy benefit manager (PBM) Express Scripts, highlights trends in drug spend, defined as year-over-year percent changes in per-member-per-year (PMPY) spending on prescription drugs, inclusive of self-administered specialty drugs paid under the pharmacy benefit. The analysis includes prescription drug use data of 33.6 million members with a pharmacy benefit plan administered by Express Scripts. Nonprescription medications (except for diabetes supplies billed under the pharmacy benefit), vaccines, prescriptions that were dispensed in hospitals, long-term care facilities, and other institutional settings, and medications billed under the medical benefit at any time in 2018 or 2019 were excluded. Total trend comprised of utilization trend and unit cost trend. 

According to the findings, prices for brand-name prescription drugs increased 4 times the rate of common household goods over 6 years. From January 2014 through December 2019, the most commonly used brand drugs experienced list price inflation of 70.5% and prices for most commonly used generic medication declined 40.9%.

The top therapeutic areas that experienced the most trend pressure in 2019 included:

• Inflammatory conditions such as rheumatoid arthritis (RA), psoriasis, and other autoimmune conditions

• Diabetes

• Oncology

• HIV

Oncology drugs had the highest PMPY spend in 2019 and contributed 36.4% of the increase in spending for Medicare, Express Scripts said. As with commercial plans, inflammatory conditions were also the highest contributors for trend (23.9%) for Medicaid, driven primarily by a 15.5% unit cost trend, Express Scripts noted. However, diabetes drugs had the highest PMPY spend for Medicaid plans, the report found.

In contrast, drugs used for pain and inflammation, asthma, mental health, and high cholesterol experienced some relief, demonstrating declines in unit costs and overall spending for payers in 2019.