While private drug plans spent more on specialty medications in 2019, that amount was lower than 2018’s 6.9 per cent increase. Members used Express Scripts for retail and home-delivery pharmacy services; they used Accredo, the Express Scripts specialty pharmacy, for specialty drug prescriptions. Download your copy today! In Medicaid, net spending on specialty drugs roughly doubled over the same period, reaching $9.9 billion in 2015. Looking ahead to the next decade, Express Scripts remains committed to delivering care that’s simpler and more affordable for patients and payers. We estimate that in 2019, retail, mail, long-term care, and specialty pharmacies dispensed about $161 billion in specialty pharmaceuticals. 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. Digital Health Formulary helps patients take better control of their health and eliminates the burden of evaluating thousands of digital health solutions on the market. The amount of money spent on specialty drugs in the government’s Medicare’s Part D prescription plan soared to nearly $33 billion in 2015 from $8.7 billion in … Davy James, Managing Editor. 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. Metrics were calculated by dividing totals by the total number of member-months (which was determined by adding the number of months of eligibility for all members in the sample) multiplied by the number of months per period. Dive Insight: The report underscores the dramatic effects specialty drugs are having on the healthcare system. Specialty drugs will continue to drive prescription drug expenditures in 2019. 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. We expect the clinic sector to continue to experience high (11-13%) growth in drug spending in 2019. Total trend comprised utilization trend and 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. In 2019, Part D enrollees’ average out-of-pocket cost for 11 orally administered cancer drugs was $10,470, according to the JAMA study. HIV: In 2020, generics for Selzentry® (maraviroc) and Truvada® (emtricitabine-tenofovir) are expected to lower unit cost trend, while utilization rates should increase. Specialty drug price inflation is predicted to be 4.23 percent in 2020. Keeping prescriptions affordable for plan members continues to be a key priority. Trend and other measures were calculated separately for those members with commercial insurance coverage. After that, two more brands are expected to gain FDA approval, driving unit cost trend up in 2022 as utilization steadily increases. A new Congressional Budget Office report Prices for and Spending on Specialty Drugs in Medicare Part D and Medicaid finds that net spending on specialty drugs to treat chronic, complex and rare conditions in Medicare Part D rose from $8.7 billion in 2010 to $32.8 billion in 2015. Specialty drug prices will continue to rise. For beneficiaries in the Medicare Part D program who took brand-name specialty drugs, average annual net spending The source for data in this presentation is CVS Health Enterprise Analytics unless otherwise noted. From Jan. 2014 through Dec. 2019, the most commonly used brand drugs experienced list price inflation of 70.5%. Client-specific modeling available upon request. Drug spending exceeds inpatient spending in some cases. In Medicaid that spend doubled from $4.8 to $9.9 billion over the same period. Meanwhile, overall pharmacy benefit cost growth is expected to slow in 2019 and 2020. Examples of these in the current news cycle are Zolgensma, which is priced about $2 million to treat spinal muscular atrophy, and CAR-T therapy which can run as high as $1 million all … Total trend measured the rate of change in gross costs, which included ingredient costs, taxes, dispensing fees and administrative fees. 4 Reinke, Thomas (September 18, 2019). At some plan sponsors, total drug spending even declined. Total trend could rise slightly, reflecting higher drug prices, as insulins are considered biologics from March 2020. We use cookies and similar technologies to understand how you use our site and to create more valuable experiences for you. 1. Together, they bring the promise of simplicity, predictability and, above all, affordability to high-priced insulin, gene therapies and the emerging world of digital health – for 2020 and beyond. 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. By 2016, 3 out of every 5 new drugs approved by the Food and Drug Administration (FDA) will be specialty drugs. Employers spent $83.9 billion on prescription drugs in 2016. Specialty Drug Spend Soars. Medium-spending scenario: Spending grows at roughly the same rate in 2021 as it did from 2014 to 2019 and was expected to in 2020. At $11.75 for a 30-day supply, member average out-of-pocket costs increased only 19¢ or 1.6%. Our overall purpose for this blog is to review the history of approvals and trends since 1990 for specialty medically covered drug. Express Scripts Pharmacy Increases Adherence and Savings, 2021 Medicare Star Ratings: By the Numbers. 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. Do you have questions about your plan’s drug trend? For estimated trend data and other details, please contact your Express Scripts account or sales team. At 1.4 percent, overall trend in 2019 was the lowest in five years, despite increases in prescription utilization and ongoing manufacturer-driven price inflation. Due to growing patient utilization rates, a pipeline of expensive new specialty drugs, and ongoing drug manufacturer price increases specialty expenditures are expected to account for 50 percent of all drug spending by 2018. Wednesday, March 27, 2019. Specialty trend … 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. A report by America's Health Insurance Plans (AHIP) projected that drug spending in the US will grow to $590 billion by 2020, up from $337 billion just a few years ago. Per-capita Medicare Advantage spending grew 6.3% in 2019… 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. We’re personalizing health services to help people live healthier lives through breakthrough solutions like these: Patient Assurance ProgramSM ensures that every person living with diabetes who needs insulin pays no more than $25 per 30-day supply – even for brands that cost hundreds of dollars per prescription. All products on this list require prior authorization for coverage and quantity limits may apply. Launched in 2017, Advanced Opioid Management (AOM) has proven successful in helping enrolled plans keep opioid prescriptions to 7 days or less for 96.5% of patients. Tweet. Now, we predict it will hit 60% by 2021. Nonprescription medications (except for diabetic supplies billed under the pharmacy benefit), vaccines, prescriptions that were dispensed in hospitals, long-term care facilities, and other institutional settings, and medications billed under the medical benefit at any time in 2018 or 2019 were excluded. Multiple generics for Pradaxa® (dabigatran etexilate) are expected toward the end of 2021, helping to reduce unit cost trend into 2022. MRx Pipeline is a quarterly report offering clinical insights and competitive intelligence on anticipated specialty and traditional drugs in the pipeline. Net spending on specialty drugs in Medicare Part D rose from $8.7 billion in 2010 to $32.8 billion in 2015. 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. The specialty pharmacy marketplace is forecast to hit … Conclusion: We predict continued moderate growth of 4-6% in overall drug expenditures (across the entire U.S. market). The balance of medication spending is strongly shifting from traditional to specialty drugs, which will continue over the next several years, according to a new report by the IQVIA Institute. Specialty drugs currently represent 39 percent of the overall pharmacy benefit spend but are projected to grow to 48 percent by 2020. While private drug plans spent more on specialty medications in 2019, that amount was lower than 2018’s 6.9 per cent increase. Gross cost does not exclude member cost share, and it is net of rebates adjusted for other pharmaceutical reimbursements. Percent of total drug spend by drug type, 2019 0 Proactive approaches to swiftly increasing levels of specialty medication spending and other … The Policy describes how you can control the use of cookies at any time. Developed through in-depth data analysis and supported by broad national experience, the Magellan Rx Management Medicaid Pharmacy Trend Report examines clinically appropriate drug use and cost-saving opportunities for Medicaid fee-for-service (FFS) pharmacy programs. I… In 2021 and 2022, several others may follow, including cenicriviroc and pegbelferming, driving high unit cost trend. The use of specialty medicines grew by 5%, more than twice the rate of other drugs, and now represents 2.2% of volume. PSG’s State of Specialty Spend and Trend Report details specialty drug utilization and gross spending through the lens of PSG’s proprietary Artemetrx ® platform, which provides an integrated view of specialty costs. 3. Specialty medicines have accelerated to the head of the pack to drive all spending growth in developed markets as non-specialty medication spending declines. Unit cost trend was defined as the rate of change in costs due to inflation, discounts, drug mix and member cost. Patients in a prior study who had their asthma monitored remotely by pulmonary pharmacists from our Therapeutic Resource Center℠ saw an 80% reduction in the daily use of their rescue medications and a concomitant increase in use of their controller medications vs. those who didn’t participate in remote monitoring. Inflammatory conditions: New formulations for drugs to treat ulcerative colitis and new medications for atopic dermatitis may impact the market in 2020. 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. Specialty drug spend forecast: The stakes are high. 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. Net spending on specialty drugs in Medicaid roughly doubled from 2010 to 2015, rising from $4.8 billion to $9.9 billion. This enabled us to deliver low net trend and single-digit specialty trend for a broad cross-section of clients, covering more than 25 million commercially-insured lives. Trend forecast: What could drive drug spending for the next 3 years? Traditional net spending on drugs decreased 0.4 percent from 2018 to 2019. Member costs declined year-over-year. , 2021 Medicare Star Ratings: by the Food and drug Administration ( FDA ) will be drugs! 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