Specialty medication costs increased again in 2016, but spending on hepatitis C medication dropped by 34%, signaling a trend for coming years, according to one pharmacy benefits management company. The same report showed spending in inflammatory conditions and diabetes rose, accounting for more than 20% of total spending.
“Medications for hepatitis C decreased in spend by 34.0% in 2016 due to declines in utilization and unit cost,” Express Scripts states in its 2016 Drug Trend Report. “The previous high utilization trend has now reversed since those with advanced hepatitis C, those most likely to seek curative therapy, have completed treatment. While the initial surge of patients on curative therapy has ended, current and future hepatitis C patients benefit from increased access to these therapies and unit cost decline.”
Hepatitis C was the only class to show a decline in spending, with a 27.3% decrease in use and a 6.7% decrease in unit cost, which the report attributed to increased competition. Harvoni (ledipasvir/sofosbuvir, Gilead Sciences) and Viekira Pak (ombitasvir/paritaprevir/ritonavir with dasabuvir, AbbVie) maintained top billing, representing a combined 42.9% of market share.
HCV dropped to 11 in spend ranking and Express Scripts projected a continued decline for HCV medication spend, ranging from 21.8% in 2017 to 34.7% in 2019. Ledipasvir/Sofosbuvir ranked fifth for specialty drug spend overall with a 53.8% decrease in use and unit cost from 2015.
Conversely, inflammatory conditions took the top spend rank in 2016 with an upward trend of 26.4%. Express Scripts attributed this trend to increased unit costs for both Humira (adalimumab, AbbVie) and Enbrel (etanercept, Amgen), which together accounted for 70% of market share in the inflammatory category.
Adalimumab ranked as No. 1 followed by etanercept at No. 2 for spending of specialty therapy drugs. The pen version of adalimumab comprised 11.3% of the total specialty drug spend with 10.45% increase in use and 17.9% increase in unit cost. Etanercept comprised 6.7% total spend despite a 4.3% decrease in use; unit cost, however, increased by 10.9%.
Rounding out the top 10 specialty drugs by spending was traditional adalimumab with 2.1% of total spending and an 18.8% trend increase and Stelara (ustekinumab, Janssen) with 2% of total spending and a 21.9% trend increase.
“Trend will remain around 30% year over year through 2019, reflecting increases in cost and utilization,” the report states. “Although biosimilars for Humira and Enbrel have been approved by the U.S. Food and Drug Administration (FDA), several biosimilar-related patent disputes have prevented their launch.”
Looking at traditional drugs, diabetes topped the spending chart with an upward trend of 19.4% — 5.3% increased use and a 14.1% unit cost increase.
Diabetes drugs held the top three spending spots in the traditional medication category. Lantus (insulin glargine, Sanofi Aventis) was the most expensive, followed by Humalog (insulin lispro injection, Eli Lilly), then metformin. Metformin showed a 152.4% increased unit cost in 2016. Januvia (sitagliptin, Merck) ranked sixth in total spend.
“Diabetes trend will continue to be near 20% for each of the next 3 years, reflecting increasing drug prices and utilization. The forecasted trend is expected to reflect a continued increase in the utilization of DPP-4 and SGLT2 inhibitors, which are prescribed as additive therapy for controlling blood sugar,” per the report.
Other notable spending
Oncology ranked third in overall spending, with a 19.7% upward trend when calculating traditional and specialty medications together. Traditional oncology medications such as tamoxifen saw a 6.5% decrease in their overall spend. Revlimid (lenalidomide, Celgene), capecitabine and combined generic and brand versions of imantinib (Gleevec, Novartis Pharmaceuticals) held the most market share.
“Trend in this class will continue to increase more than 20% in each of the next 3 years. The use of oncology medications by patients as maintenance therapy will result in increased utilization of expensive medications. Additionally, the increasing prevalence of self-administered medications will result in higher utilization and cost through the pharmacy benefit,” the report states. “The first generic to Gleevec launched in February 2016 and resulted in limited savings; however, the availability of generics will not offset the high prices of branded oncology drugs.”
HIV came in sixth for spend ranking, but had an upward trend of 21.7%, which Express Scripts attributed to a 16.2% increase in unit cost. Truvada (emtricitabine/tenofovir disoproxil fumarate, Gilead Sciences) ranked eighth out of specialty drugs with 2.1% of spending.
“HIV medications are predicted to continue trending approximately 20%. Some increased patient volume will be due to higher rates of screening and longer lives for HIV patients, as well as pre-exposure prophylaxis (PrEP) use,” the report states. “The convenience and improvement of newer therapies that combine several drugs in a once-daily dose will continue to increase utilization in the class.” – by Katrina Altersitz
Express Scripts. 2016 Drug Trend Report; 2016. Available at: https://lab.express-scripts.com/lab/drug-trend-report. Accessed February 15, 2017.