Report: Diabetes drives traditional drug trend, specialty trend increases 20%

Diabetes accounts for a major share of the increase in traditional drug trend, according to a new report.

Diabetes has the highest trend of any top traditional therapeutic class at 21.1%, according to Catamaran’s 2015 Informed Trends Report. This is predominantly driven by increases in medication costs-with insulin alone accounting for 30% of the unit cost increase for traditional trend.

Catamaran’s overall drug trend more than doubled, increasing from 2.4% in 2013 to 5.7% in 2014. In 2013, traditional drug spending decreased, helping to lower overall trend, whereas, in 2014, traditional trend increased 1%, adding to overall trend. The traditional increase was largely due to a 21% increase in the diabetes class, with insulin alone accounting for 30% of the price increase across all traditional drugs. Since approximately 30 million Americans have diabetes and 86 million Americans have pre-diabetes, this has the potential to significantly increase traditional prescription drug spending over the next several years. 

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Spending on specialty medications increased 20% in 2014, compared to a 14.3% drug trend in 2013. The top 5 specialty classes by spend were autoimmune, multiple sclerosis, cancer, hepatitis C and HIV/AIDS.

Related: Specialty drugs: a good value, despite high costs

Key findings from 2014 include that specialty medications accounted for 28% of total drug costs but only 1% of claims, “bringing to light the need for utilization management programs for these drugs in order to reach the best clinical outcome at the best value,” said Sumit Dutta, MD, MBA, chief medical officer at Catamaran. “Additionally, we shared that members being treated with expensive new hepatitis C therapies through Catamaran’s BriovaRx specialty pharmacy showed 9.1% better adherence.

“We recommend a thoughtful approach to plan design and formulary management as well as using clinical programs that promote optimal health outcomes while being cost-effective,” Dr Dutta added.

The report also provides key insights into the 1.3 million members from the health insurance marketplace (HIM). In 2014, this group spent 5 times as much on viral-related diseases-including HIV/AIDS and hepatitis C-than Catamaran's commercial population; 48% of HIM enrollees' pharmacy spend was in the specialty drug category. Dispelling the notion, however, that this population's pharmacy benefit would be more costly than a typical, traditional health plan, Catamaran saw the group begin to trend younger and healthier later in the year:

• 64% of enrollees were aged 45 years and older in the first quarter, but this decreased to 55% by the fourth quarter

• Average cost per utilizer went from $338 to $171 during the same time period.

• 29% of early enrollees were treating 5 or more conditions compared to only 16% of year-end enrollees.

Catamaran analyzed its commercial book of business from calendar years 2013 and 2014 to determine drug trend. Overall drug trend includes both traditional and specialty drugs.

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