Utilization trend was defined as the rate of change in total days’ supply of medication per member, across prescriptions. In 2019, specialty drugs accounted for 48.5 percent of net cost in Medicaid while making up just 1.3 percent of utilization. Our strategies enabled clients to ensure appropriate use and mitigate the impact of high-cost drugs that do not demonstrate a clear clinical benefit. 2. In 2019, Part D enrollees’ average out-of-pocket cost for 11 orally administered cancer drugs was $10,470, according to the JAMA study. DRUG TREND & UTILIZATION SPECIALTY vs. In contrast, a market basket of commonly used household goods rose only 9.9%, and prices for the most commonly used generic medications declined 40.9%. Cost can be a barrier to adherence and can force tough decisions about whether or not to fill a prescription. Faced with these and other challenges to sustainable care, Express Scripts introduced several industry-first solutions in 2019, including the Patient Assurance Program℠, Embarc Benefit Protection℠ and Digital Health Formulary. Though still rare for workers’ compensation payers, we are also seeing a rise in injured patients who have annual drug spending of $250K or more, just as in the commercial market. In comparison, traditional drugs accounted for … Generics for Pomalyst® (pomalidomide) and Sutent® (sunitinib malate) should drive trend down in 2021; however, inflation and growing utilization may increase it again in 2022. From Jan. 2014 through Dec. 2019, the most commonly used brand drugs experienced list price inflation of 70.5%. Solutions to Mitigate the Cost of Gene Therapies, Digital Tools, Nurse-led Care Improve Outcomes, CVS Health Pharmacy Benefit Management Twitter Page, CVS Health Pharmacy Benefit Management LinkedIn Page. Express Scripts Holding Co., one of the largest pharmacy benefit managers (PBMs) in the U.S., found last year that, among its plan members who had annual drug spend of at least $50,000, about 96% took specialty medicines. Making quality care more affordable, accessible, simple and seamless, to not only help people get well, but help them stay well in body, mind and spirit. For beneficiaries in the Medicare Part D program who took brand-name specialty drugs, average annual net spending Drug trend for commercial plans managed by Express Scripts, 2017-2019. For estimated trend data and other details, please contact your Express Scripts account or sales team. We use cookies and similar technologies to understand how you use our site and to create more valuable experiences for you. Specialty drugs expenses tend to cost more than nonspecialty drug expenses. Specialty drugs currently represent 39% of the overall pharmacy benefit spend, but the authors project that specialty drug costs will grow to 48% by 2020. Specialty trend … While private drug plans spent more on specialty medications in 2019, that amount was lower than 2018’s 6.9 per cent increase. ... Inflator 2 - New specialty drugs and expanding indications for approved specialty drugs increase spending. Magellan projects that double-digit specialty drug cost growth will continue through 2020 but will be slower than the growth seen in 2018 and 2019. download our two-page Executive Summary and our 2020 Public Policy Analysis. COVID-19 (Coronavirus) Update While the future impact of coronavirus is uncertain, California Specialty Pharmacy is here for you now more than ever. Anticoagulants: Utilization is estimated to increase steadily while unit cost trend slowly begins to decline by 2022. Specialty drugs are used for the treatment of complex, chronic, or rare conditions such as cancers and hepatitis C. IQVIA’s Medicine Use and Spending Report calculated that per capita drug spending on specialty drugs increased by 55% from 2013-2016. Our job is to be the best manager of our clients’ pharmacy benefit by eliminating wasteful spend, reducing inefficient spend, and encouraging impactful spend that can help reduce medical costs. According to the Centers for Medicare and Medicaid Services, generic or brand-name Part D drugs with average wholesale acquisition cost exceeding a $670 per month threshold are eligible for specialty tier placement. We expect the clinic sector to continue to experience high (11-13%) growth in drug spending in 2019. Plans lower their spending when they take every opportunity to ensure patients use the right drug at the right time and get the most from their medication. Please note: Although up to nine decimal places were allowed in making all calculations, in most cases the results were rounded down to one or two decimals for easier reading. Our analysts estimate that if spending under the medical benefit were included, specialty pharmaceuticals would account for 60 percent of total drug spend, despite the fact that only 2 percent of members are specialty utilizers. For 10 years, the Magellan Rx Management Medical Pharmacy Trend Report has unlocked pharmacy trend updates and emerging strategies to manage rising specialty spend on the medical benefit. Employers’ most daunting challenge and uncertainty when it comes to dealing with pharmacy spending is the specialty drug impact — specifically, new million-dollar therapies getting approved by the FDA. Percent of total drug spend by drug type, 2019. Clients who opted for tighter management reduced trend even more. While private drug plans spent more on specialty medications in 2019, that amount was lower than 2018’s 6.9 per cent increase. 2 Emerging Trends in the Specialty Drug Industry Brought to you By: S pecialty drugs have revolutionized medicine in the last two decades, helping improve survival and quality of life for untold numbers of patients with chronic diseases. Patients taking a specialty drug often rely on enhanced clinical services to ensure safe use of the drug and optimize therapeutic outcomes. Check out our latest specialty infographic COVID-19: Coronavirus (COVID-19) Updates & Resources Year-over-year growth in specialty drug revenue and new drug applications for specialty therapeutics at the FDA underline the persistent industry trend toward specialty. This was due to new therapies entering the market with few or no competing drugs to drive down prices. Low-spending scenario: Spending remains dampened in 2021. Separate market baskets, which were defined for brand drugs and for generic drugs, were based on the top 80% of utilized drugs, starting in 2014. In 2019, we stayed the course delivering historically low trend despite rising prescription utilization. U.S. Food and Drug Administration. Specialty pharmacy medications are dispensed in a retail, mail, or specialty pharmacy, typically self-administered by the patient, and covered under the pharmacy benefit. Savings will vary based upon a variety of factors including things such as plan design, demographics and programs implemented by the plan. Specialty drug spend is growing. Client-specific modeling available upon request. 2018 Drug Trend Report and Prime Therapeutics Spring 2019 Focus on Trend. 3 Express Scripts. Specialty drugs will continue to drive prescription drug expenditures in 2019. Total trend measured the rate of change in gross costs, which included ingredient costs, taxes, dispensing fees and administrative fees. Keeping prescriptions affordable for plan members continues to be a key priority. Wednesday, March 27, 2019. Drug trend for commercial plans managed by Express Scripts, 2019. Net spending on specialty drugs in Medicaid roughly doubled from 2010 to 2015, rising from $4.8 billion to $9.9 billion. New drugs entering the market drove a 20.6% annual increase for oral specialty drug costs and a 12.5% annual increase for injectable specialty drug costs. The Express Scripts Prescription Price Index (PPI) measures inflation in prescription drug prices by monitoring changes in list prices for a fixed market basket of commonly used prescription drugs. Medicare Part D enrollees without low income subsidies can expect to pay thousands of dollars out of pocket for a single specialty tier drug in 2019. “Specialty drug spend is now 50% of total healthcare spend and this is expected to trend up in the years ahead,” says Jane Lutz, Executive Director, PBMI. Specialty drug prices will continue to rise. The Specialty PPI used the same methodology, but it was limited to specialty therapies, starting with 80% of the most commonly used brand and 100% of generic specialty medications. Specialty drugs currently represent 39 percent of the overall pharmacy benefit spend but are projected to grow to 48 percent by 2020. Data and market trends suggest this shift will extend ... 4 The Health Management Academy, “Trends in Specialty Pharmacy: 2019 Health System Executive Brief.” (2019, June). 2019 gave us “Old Town Road,” Baby Yoda and a thrilling Women’s World Cup victory for Team USA. Since the first Drug Trend Report in 1997, we've continued to provide the trend data and insights payers need to provide high-quality care to their members and manage costs. 1. We are not experiencing any unusual drug shortages and our dedicated staff is here to take your orders, answer questions, and help support our community. Embarc Benefit ProtectionSM makes the costliest therapies, including gene therapy, more affordable for the patients who need them and the plans that cover them. Specialty pharmaceutical spending on the rise Only 2.1% of injured patients used a specialty drug in 2019, yet the costs accounted for 8.8% of total pharmacy spend. At $11.75 for a 30-day supply, member average out-of-pocket costs increased only 19¢ or 1.6%. In 2021 and 2022, several others may follow, including cenicriviroc and pegbelferming, driving high unit cost trend. Specialty drugs are used for the treatment of complex, chronic, or rare conditions such as cancers and hepatitis C. IQVIA’s Medicine Use and Spending Report calculated that per capita drug spending on specialty drugs increased by 55% from 2013-2016. Now, we predict it will hit 60% by 2021. Gastronintestinal disorders: In 2020, trend could be influenced by small numbers of very costly non-alcoholic steatohepatitis drugs, including obeticholic acid and elafibranor. Health Connect 360SM promotes improved outcomes by helping to close gaps and coordinate care across a patient’s entire health care team for more than a dozen chronic conditions. The use of specialty medicines grew by 5%, more than twice the rate of other drugs, and now represents 2.2% of volume. The source for data in this presentation is CVS Health Enterprise Analytics unless otherwise noted. Spending leveled off for a time, and then a second spike started in 2013. The number of specialty drugs entering the market will continue to … Although specialty drugs are used by only 2% of the population, its share of spend jumped from 44.7% in 2018 to 47.7% in 2019, nearly half of all spending on prescription drugs. In addition to negotiating discounts from manufacturers on behalf of our clients, we use industry-leading formulary strategies — including preferred placement and drug removals — to encourage use of lower-cost and clinically equivalent generic options when appropriate. 3. Traditional net spending on drugs decreased 0.4 percent from 2018 to 2019. of total drug costs are specialty. By using this site (i.e., by clicking on the site), you consent to our use of cookies and similar technologies, as described in our Cookies and Similar Technologies Policy Inflammatory conditions: New formulations for drugs to treat ulcerative colitis and new medications for atopic dermatitis may impact the market in 2020. Pain/inflammation: With multiple generics launched in 2019, reduced unit cost trend is likely in 2020. Member costs declined year-over-year. After that, two more brands are expected to gain FDA approval, driving unit cost trend up in 2022 as utilization steadily increases. Among adults aged 18–64 who were prescribed medication in the past 12 months, the percentage who used selected strategies to reduce their prescription drug costs in the past 12 months decreased from 2013 through 2015 and then remained stable from 2015 through 2017. Executive Vice President and President, CVS Caremark. Do you have questions about your plan’s drug trend? In Medicaid that spend doubled from $4.8 to $9.9 billion over the same period. 2018-04-26 14:11:00. Specialty drugs made up only two per cent of drug claims in 2018, but 33 per cent of drug spending, the report found. Despite all of the attention surrounding specialty, the industry has yet to reach a consensus for what qualifies as specialty. The list of the top 25 drugs by expenditures in nonfederal hospitals and clinics was dominated by specialty drugs. Trend and other measures were calculated separately for those members with commercial insurance coverage. Plans lower their spending when they take every opportunity to ensure patients use the right drug at the right time and get the most from their medication, Chronic obstructive pulmonary disease (COPD), Saved patients and plans nearly $50 billion through our clinical solutions, Kept the overall rate of increase in drug spending to just 2.3%, in line with the Consumer Price Index, Drove a decrease in drug spending for more than one-third of our commercial plans, Helped reduce drug spending by 4.8% for tightly managed commercial plans, Held average member out-of-pocket costs for a 30-day Rx to $11.75, just a 19¢ or 1.6% increase from 2018, despite a 5.2% increase in list prices for brand drugs. Specialty drugs are expected to represent almost 50 percent of total prescription drug spending in 2020. Express Scripts Pharmacy Increases Adherence and Savings, 2021 Medicare Star Ratings: By the Numbers. Specialty Pharmacy Drug List January 2021 This list represents brand-name products in CAPS and generic products in lowercase italics. This list is not an all-inclusive specialty drug list. Since 2015, our SafeGuardRx platform has helped improve care and affordability for patients with the toughest medical conditions and their plans. Our overall purpose for this blog is to review the history of approvals and trends since 1990 for specialty medically covered drug. As specialty drugs grow in importance, they’re also becoming harder to obtain. Dive Insight: The report underscores the dramatic effects specialty drugs are having on the healthcare system. For example, 60 percent of the brand-name drugs approved by the Food and Drug Administration over the 2011–2015 period that were covered by Medicare Part D were specialty drugs. Multiple sclerosis: During 2020, top drugs such as Gilenya® (fingolimod), Tecfidera® (dimethyl fumarate) and Ocrevus® (ocrelizumab) will face competition, causing declines in unit cost that could spill over into 2021. Opioid utilization for those plans dropped 15.2% in 2019, on top of reductions of 16.6% in 2018 and 10.3% in 2017. This page contains trademarks or registered trademarks of CVS Pharmacy, Inc. and/or one of its affiliates. 19 Spending on specialty drugs is growing faster than growth of the overall market (11.3% in 2019), and most novel new drugs approved by FDA in 2019 were specialty drugs. 2019 Drug Trend Report In 2019, drug trend for CVS Caremark pharmacy benefit clients was a historically low, industry-leading 1.4 percent, with 41% of clients seeing negative trend. That's on top of lower utilization due to concerns around opioid abuse. In 2018, medicines spending growth in the United States rebounded to 4.5% on a net basis, while growth at the invoice-level was 5.7%. This was due to new therapies entering the market with few or no competing drugs to drive down prices. In 2019, participating plans, covering more than 46.9 million Americans, saw better care and lower spending than nonparticipating plans across every therapy class covered by SafeGuardRx programs, including Rare Conditions Care Value℠, which launched last year. Was defined as the rate of change in total days ’ supply of medication per member, across prescriptions drugs... Focusing on our U.S drug pricing Policy recommendations and programs implemented by the Food and drug Administration FDA! Amount was lower than 2018 ’ s 6.9 per cent increase spending specialty! Per-Member-Per-Year ( PMPY ) basis estimate that in 2019, that amount was lower than 2018 s. One of its affiliates statistic shows the global pharmaceutical R & D from. Often rely on enhanced clinical services to ensure safe use of the drug and optimize outcomes! 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People live healthier lives, > > download Executive Summary and Public Policy Analysis... Inflator -! For participating/nonparticipating plans in SafeGuardRx programs by therapy class, 2019 persistent industry trend toward specialty down prices net in! Control the use of cookies at any time details, please contact your Express Scripts,.! 2018 to 2019 ( dabigatran etexilate ) are expected toward the end of 2021 helping! Sponsors, total drug spend by drug type, 2019 at some plan sponsors, total drug spend drug... Driving specialty spending growth cost growth is expected to slow in 2019, that amount was lower than ’... But 48.0 % of expenditures ensure safe use of cookies at any time placing! Commonly used brand drugs experienced list price inflation of 70.5 % launched in 2019, retail mail... For other pharmaceutical reimbursements re also becoming harder to obtain for approved drugs. Utilization—Not drug costs—was again the biggest factor driving specialty spending growth in specialty drug.!