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Express Scripts Reports Prescription Drug Spending Slowed in 2016
The largest pharmacy benefit manager (PBM) in the United States, Express Scripts, recently reported that growth in prescription drug spending among its members slowed to less than 4% between 2015 and 2016—a time when drug price spending is being heavily scrutinized.
PBMs have recently taken an increasingly aggressive stance in drug price negotiations. Express Scripts programs are aimed at minimizing waste and maximizing savings, according to a press release.
“In a year where the issue of high drug prices was No. 1 on the list of payer and policy maker concerns, the data show that our solutions protected our clients and patients,” Glen Stettin, MD, chief innovation officer at Express Scripts, said in a press release. “By practicing pharmacy smarter, we uniquely make medicine more affordable and accessible for patients. We do this by driving down drug prices and ensuring appropriate use of clinically-proven medicine, while helping employers remain competitive.”
The overall growth of rate per-person spending on prescription drugs slowed to 3.8% in 2016—a 27% decrease from 2015, according to the 21st edition of the annual Drug Trend Report by Express Scripts.
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According to an Express Scripts press release, “If all pharmacy plans across the country tightly managed their benefit, the United States could have saved an additional $5.8 billion on prescription drugs last year, while maintaining a clinically sound and affordable pharmacy benefit for American patients.”
For the second consecutive year, patients covered under Express Scripts paid 14.6% of the total cost of a prescription medication in 2016 compared to 14.8% in 2015. However, the average cost for patients paying out-of-pocket for a 30-day prescriptions was $11.34 in 2016—roughly a dime more than 2015.
According to the report, commercial plans only had a 2.5% increase in unit costs across all medications—nearly 22% lower than 2015, and more than 60% lower than the increase in prices and net of rebates that have recently been reported by drug makers.
“Rebates do not raise drug prices, drugmakers do," Dr Stettin said. “As demonstrated by lower overall and unit cost trend in 2016, 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 report showed that common list prices for brand name drugs increased nearly 11% in 2016. The base price set in January 2008 was $100.00. In December 2016, the prices set for the most commonly used brand medications increased to $307.86—a nearly 208% increase. Comparatively, the prices for the most commonly used generic medications declines to 8.7% in 2016.
For specialty drug spending, Express Scripts reported an increase of 13.3% in 2016, a decrease from the 17.8% trend in 2015. This is said to be the lowest trend since Express Scripts included specialty medications in our annual analysis in 2003. However, medications to treat inflammatory conditions and diabetes remain to be the costliest.
According to the findings, employers on average paid $3587.83 per prescription for medication to treat inflammatory conditions such as rheumatoid arthritis. Specifically, Humira (adalimumab; AbbVie) and Enbrel (etanercept; Amgen) were major trend drivers for the class, with unit cost increases between 10% and 18%. For diabetes medications, overall spending increased to 19.4% in 2016, driven by a 14.1% increase in unit cost. The average out-of-pocket cost for insulin was $36.69 per prescription—$1.63 more than in 2015. The third costliest drug class, oncology, increased nearly 22%. Despite savings from generics, unit costs for oral oncology medications increased 9.6% in 2016. The list prices for drugs doubled between 2011 and 2016 from $20 per unit to $40 per unit.
“The trends observed in these three leading therapy classes demonstrate the need for our industry leading SafeGuardRx solutions,” said Dr. Stettin. “Recent enhancements to our Oncology Care Value Program, and the launches of our Inflammatory Conditions and Diabetes Care Value programs, will help employers better manage spending in these areas through novel, indication-based reimbursement approaches, inflation protection and distinctive clinical care that has proven success with improving patient outcomes.”
—Julie Gould (Mazurkiewicz)
