MArch The 2014 Drug Trend Report Highlights
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1 MArch 2015 The 2014 Drug Report Highlights
2 Highest Increase in U.S. Drug Spend Over Past Decade In 2014, the pharmacy landscape underwent a seismic change, and the budgetary impact to healthcare payers was significant. U.S. prescription drug spend increased 13.1% in 2014 the largest annual increase since 2003 and this was largely driven by an unprecedented 30.9% increase in spending on specialty medications. Utilization of traditional medications stayed flat (-0.1%), while the use of specialty drugs increased 5.8%. The largest factors contributing to the increased spending, however, were the price increases for these medication categories 6.5% for traditional and 25.2% for specialty. While specialty medications represent only 1% of all U.S. prescriptions, these medications represented 31.8% of all 2014 drug spend an increase from 27.7% in COMPONENTS OF OVERALL DRUG TREND EXPRESS SCRIPTS % Increased inflation and utilization of hepatitis C and compounded medications were the most significant accelerators of U.S. drug spend in Excluding those two therapy classes, overall drug spend would have increased only 6.4% More than 15% of Express Scripts clients spent less, per capita, on prescription drugs in 2014 than in Closely managed pharmacy plans spent nearly 30% less per member on traditional medications, when compared to unmanaged plans Express Scripts hepatitis C solution, announced in December 2014, will save its clients more than $1 billion in 2015 on hepatitis C medications, while expanding treatment to all patients who need it. Overall Drug Traditional Drug Specialty Drug Express Scripts compound management solution, implemented in waves through the last half of 2014, will save its clients more than $1.9 billion in 2015 that would have otherwise been wasted on compounded medications that do not provide a proven clinical benefit. the express scripts 2014 drug trend report executive summary 2
3 HIGHLIGHTS AND COMPONENTS OF DRUG TREND BY POPULATION Commercially Insured Overall drug spend increased 13.1% in 2014, following several years of increases below 6%. Market forces and changes in patient behavior impacted drug expenditures in 2014, but brand drug pricing was one of the most important factors driving trend, especially for specialty medications. Medicare The total spend for Medicare plans rose 13.8% in 2014, to $2,987.36, as a result of a modest increase in utilization (0.5%) combined with a significant increase in unit cost (13.3%). Traditional drug spend increased 6.4%, driven by relatively stable utilization and a 5.9% increase in unit cost. Although specialty medications represented only about onequarter of total Medicare drug spend, their contribution to trend was significant: specialty spend increased 45.9% in 2014, following a much more modest increase of 14.7% in Medicaid Overall trend for Medicaid plans was 10.2% in 2014, due primarily to a 10.7% increase in unit cost. Utilization was marginally negative (-0.5%), reflecting the influx of new, adult beneficiaries less likely to use medications for chronic conditions. commercially insured: COMPONENTS OF TREND 2014 PMPY Spend Utilization Unit Cost Total Traditional $ % 6.5% 6.4% Specialty $ % 25.2% 30.9% TOTAL OVERALL $ % 13.2% 13.1% January-December 2014 compared to same period in 2013 COMPONENTS OF MEDICARE TREND 2014 PMPY Spend Utilization Unit Cost Total Traditional $2, % 5.9% 6.4% Specialty $ % 34.3% 45.9% TOTAL OVERALL $2, % 13.3% 13.8% January-December 2014 compared to same period in 2013 Overall Insights For the commercially insured, compounded drugs and hepatitis C therapies were the key drivers of 2014 spend and trend. Without them, total overall trend would have been just 6.4%. Medicare plans spent an average of $ per-member-per-year (PMPY) on just 3 hepatitis C medications alone in 2014 more than the PMPY cost of the entire class of inflammatory drugs, which treat more common conditions such as rheumatoid arthritis and psoriasis. Because of Medicaid expansion under the Affordable Care Act, many young adults were newly eligible for Medicaid coverage. The decrease in utilization was partially a result of these healthier enrollees who were not using prescription medications. COMPONENTS OF MEDICAID TREND 2014 PMPY Spend Utilization Unit Cost Total Traditional $ % 3.2% 2.8% Specialty $ % 36.7% 35.8% TOTAL OVERALL $ % 10.7% 10.2% January-December 2014 compared to same period in 2013 the express scripts 2014 drug trend report executive summary 3
4 COMPONENTS OF TREND FOR THE TOP 10 COMMERCIALLY INSURED THERAPY CLASSES TOP TRADITIONAL THERAPY CLASSES TOP specialty THERAPY CLASSES RANKED BY 2014 PMPY SPEND Rank Therapy Class PMPY Spend Utilization Unit Cost Total 1 Diabetes $ % 16.3% 18.0% 2 High Blood Cholesterol $ % -3.9% -6.8% 3 Compounded Drugs $ % 128.2% 128.4% 4 Pain/Inflammation $ % 15.7% 16.0% 5 High Blood Pressure/Heart Disease $ % -12.2% -12.6% 6 Heartburn/Ulcer Disease $ % -9.2% -10.6% 7 Asthma $ % -11.6% -14.9% 8 Attention Disorders $ % 2.9% 6.3% 9 Depression $ % -20.5% -18.4% 10 Mental/Neurological Disorders $ % 9.6% 9.1% TOTAL TRADITIONAL $ % 6.5% 6.4% RANKED BY 2014 PMPY SPEND Rank Therapy Class PMPY Spend Utilization Unit Cost Total 1 Inflammatory Conditions $ % 15.7% 24.3% 2 Multiple Sclerosis $ % 9.7% 12.9% 3 Oncology $ % 11.7% 20.7% 4 Hepatitis C $ % 666.6% 742.6% 5 HIV $ % 10.3% 14.8% 6 Miscellaneous Specialty Conditions $ % 8.2% 35.6% 7 Growth Deficiency $ % 7.5% 6.6% 8 Hemophilia $ % 17.6% 16.9% 9 Pulmonary Arterial Hypertension $ % 6.2% 13.8% 10 Transplant $ % -3.1% -2.3% TOTAL Specialty $ % 25.2% 30.9% For the fourth consecutive year, medications used to treat diabetes were the most expensive traditional therapy class when ranked by PMPY spend. Additionally, the diabetes class had the largest trend with the exception of compounded drugs which jumped to third place, largely due to a 128.2% increase in the average price for these products. PMPY spend for the top three specialty therapy classes inflammatory conditions, multiple sclerosis and oncology contributed 55.9% of the spend for all specialty medications billed through the pharmacy benefit in The U.S. spent 742.6% more on hepatitis C medications in 2014 than it did in 2013; this therapy class was not among the top 10 specialty classes in the express scripts 2014 drug trend report executive summary 4
5 TREND FORECAST ( ) FOR KEY COMMERCIALLY INSURED THERAPY CLASSES TOP TRADITIONAL THERAPY CLASSES TOP SPECIALTY THERAPY CLASSES Forecast Therapy Class Diabetes 18.3% 18.3% 18.3% High Blood Cholesterol* -8.5% -14.3% -24.7% Compounded Medications -45.0% 8.0% 8.0% Pain/Inflammation 13.1% 9.4% 9.5% High Blood Pressure/Heart Disease -3.5% -6.7% -10.6% Heartburn/Ulcer Disease -31.4% -34.0% -30.7% Asthma 12.7% 9.8% 9.9% Attention Disorders 11.8% 11.0% 10.2% Depression -26.3% -10.8% -0.8% Mental/Neurological Disorders 0.7% -6.0% -5.5% Contraceptives 15.0% 11.0% 9.0% Anticoagulants 25.1% 15.5% 12.3% Other Traditional Classes 1.7% 3.1% 2.4% TOTAL TRADITIONAL -0.5% 3.9% 4.3% Forecast** Therapy Class Inflammatory Conditions 21.6% 21.6% 21.1% Multiple Sclerosis 11.3% 6.5% 3.0% Oncology 21.6% 20.4% 19.8% Hepatitis C 66.5% 55.4% 44.3% HIV 17.3% 16.6% 16.2% Miscellaneous Specialty Conditions 31.1% 29.7% 28.2% Growth Deficiency 12.5% 10.4% 10.5% Hemophilia 3.9% 3.3% 3.4% Pulmonary Arterial Hypertension 12.5% 12.0% 12.1% Transplant -5.8% -1.3% 0.0% Hereditary Angioedema 22.5% 24.2% 20.7% Other Specialty Classes 6.7% 6.7% 6.4% TOTAL SPECIALTY 22.6% 22.3% 21.3% ** is forecast only for specialty medications billed through the pharmacy benefit. *Due to uncertainty regarding price projections and regulatory guidance, PCSK9 inhibitors products were excluded from our forecast. The utilization of traditional medications is likely to increase, but the continuing decline in overall costs related to an abundance of generics and a relative lack of brand innovators in the pipeline for the most commonly used therapy classes (aside from diabetes) will keep traditional drug spend from increasing substantially. Although the specialty trend will slow to more sustainable levels in the next three years, it still is expected to experience fairly stable double-digit growth in 2015, 2016 and The major contributors to rising PMPY spend for specialty medications are brand inflation and the accelerating development of expensive, highly targeted therapies. the express scripts 2014 drug trend report executive summary 5
6 THE EXPRESS SCRIPTS PRESCRIPTION PRICE INDEX Compared to the prices of generic drugs and brand drugs a year earlier, in December 2014 generic drug prices were 20.0% lower whereas brand prices were 15.4% higher. Price increases for several commonly used generics have contributed to a slowing of the decline in prices for generic drugs as a whole. Even so, generic medications overall continue to deliver significant savings over brand-name alternatives. The Express Scripts Prescription Price Index Index $ From January 2008 through December 2014, a market basket of the most commonly used 140 generic medications decreased in price by 62.9%. During that same period, a market basket of the most commonly used brand medications increased in price by 127.4%. 100 $ In contrast, a market basket of commonly used household goods, as measured by the Bureau of Labor Statistics Consumer Price Index, grew only 11.2% during this same time period Jan 1 08 Jan 1 09 Jan 1 10 Jan 1 11 Jan 1 12 Jan 1 13 Jan 1 14 Jan 1 15 $37.13 Brand Prescription Price Index Generic Prescription Price Index Consumer Price Index (BLS) the express scripts 2014 drug trend report executive summary 6
7 the express scripts 2014 drug trend report executive summary Express Scripts Holding Company. All Rights Reserved. 14-EME27270
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