- Express Scripts forecasts large spending increases over the next few years for anti-inflammatory, diabetes and oncology drugs, according to a new report.
- The largest pharmacy benefit manager (PBM) in the U.S., Express Scripts used prescription drug data from its members to compile the "2016 Drug Trend Report," which analyzes drug spending over the last year and makes predictions through 2019 for some of the most expensive therapeutic classes.
- Overall, average list prices for brand name medicines increased nearly 11%, according to the PBM, driven mainly by specialty drug costs. Net of rebates, however, commercial plans managed by Express Scripts saw only a 2.5% rise in average unit costs.
It's no secret that pricing issues have been contentious in the last few years. And when it comes to who's to blame, both PBMs and pharmaceutical manufacturers have pointed the finger at each other. To that end, Express Scripts didn't mince words in laying out what it thought were the biggest issues facing drug costs.
"Let’s get past the rhetoric and get to the facts," the company wrote in the report. "Drug makers set the prices for their medications. They can lower those prices at any time."
"Express Scripts is effective in protecting employers from the effects of inflation by using our focused size and scale to secure significant rebates, which are returned to employers to reduce the overall cost of their pharmacy benefit."
The PBM also touted the savings it brought clients in 2016. For example, patients in healthcare plans managed by Express Scripts saw the price of their prescription drugs increase 3.8% last year, down from the 5.2% jump experienced in 2015.
Year-over-year spending through 2019 should increase about 30% for inflammatory conditions such as rheumatoid arthritis, roughly 20% for cancer medications, and about 20% for insulins and other diabetes treatments, the report said, mainly due to price hikes and growing patient populations.
Additionally, the report detailed the 15 priciest therapeutic areas based on per-member-per-year (PMPY) spend. Inflammatory conditions clocked in the highest, at $118.21, followed by diabetes at $108.80 and oncology at $60.70.
Multiples sclerosis and pain/inflammation rounded out the top five, with $58.63 and $51.64 PMPY, respectively.
Also noteworthy was that, of the most expensive therapeutic areas, five were specialty drugs and ten were traditional. On the specialty end, AbbVie's Humira (adalimumab), Amgen's Enbrel (etanercept) and Biogen's Tecfidera (dimethyl fumarate) had the most costly PMPY — ranging from $45.11 to $13.49 — while Sanofi's Lantus (insulin glargine), Eli Lilly's Humalog (insulin lispro injection) and the generic metformin led the traditional offerings.