Hospital Drug Spending to Increase through July 2024

Health systems and hospital spending will continue to increase moderately from July 1, 2023, to July 1, 2024, according to a new report from healthcare performance improvement firm Vizient. The report, Vizient’s Winter Pharmacy Market Outlook, predicts drug spending will hike 3.78% during the time frame, reflecting a growing upward trend led by an increase in prices and utilization, Vizient said in a press release.

Carina Dolan, Pharm.D.

“It is a modest increase relative to previous years, however it does represent a trend toward more significant price increases,” Carina Dolan, Pharm.D., MS.Pharm., associate vice president for Clinical Insights & Forecasting for Vizient, told Formulary Watch.

Overall, drug spending continues to be impacted by the utilization of high-cost pharmaceuticals, while innovative and specialized medications continue to be introduced, according to Dolan. “Scrutiny of inpatient pharmaceutical spending and shifting medications to the ambulatory setting where pharmacists can provide comprehensive patient care services and help optimize delivery of infusion medications can be a cost saving opportunity for a health system and provide increased access for their patients,” she said.

AbbVie’s arthritis drug Humira (adalimumab) remains the top drug in terms of total spend. The top three drugs — Humira along with Merck’s oncology therapy Keytruda (pembrolizumab) and Janssen’s anti-inflammatory therapy Stelara (ustekinumab) — combined totaled nearly $4.2 billion in Vizient member spend from October 2021 to September 2022.

Related: First Humira Biosimilar is Now Available

Hospital spending on Humira could moderate because of the wave of biosimilars about to come to market. By the end of this year, there could be at least eight such therapies available. Amgen just launched the first of the highly anticipated Humira biosimilars. Amgen is making Amjevita (adalimumab-atto) available with two pricing options. The first is a 5% below the current Humira price of $6,922 for a four-week supply. The second would be 55% below the current Humira list price.

Additional Humira biosimilars are expected to become available in the third quarter of this year. “It is likely that a steady decline in the total adalimumab spend will begin to occur once multiple products come to the market. The rate of decline will depend on payer formulary coverage,” Dolan said.

Payers’ position on coverage for biosimilar products is “vital to the uptake of these products,” she added. “If a payer prefers the branded reference product, that greatly limits the potential for biosimilar utilization. However, if a payer offers parity coverage for biosimilars, biosimilars can then be a cost-effective option for the patient.”

Several PBMs — including Optum Rx, Express Scripts and Prime Therapeutics — have already indicated they will include some of these biosimilars as preferred products alongside Humira. A spokesperson from Prime, however, said it is not adding Amjevita at this time and has no further updates. And a CVS Caremark spokesperson indicated that Humira will remain preferred and Amjevita will be placed on a non-preferred brand tier.

Vizient’s report indicates that autoimmune/inflammatory conditions and oncology therapeutics are the top categories of spending. In fact, 23% of purchases by Vizient members were for oncology therapeutics.

Keytruda is the second highest in drug spending overall and the highest in oncology. Dolan said Keytruda will continue to be at the top of the spending trend because of high utilization and high cost. Keytruda recently received approval for its 34th indication — to treat patients with non-small cell lung cancer (NSCLC) following surgery and chemotherapy. The list price for each indicated dose of Keytruda when given every three weeks is $10,683.52.

Dolan said spending on Keytruda will not likely go down anytime soon. “Additional indications as well as use in earlier lines of therapy for cancer treatments are expected over the next few years,” she said.