BCBS: Specialty drugs behind higher Rx spend
CHICAGO - U.S. prescription-drug spend in 2014 reached $373.9 billion — a 13% increase from the previous year and the largest increase in more than a decade, Blue Cross Blue Shield reported, as more effective and expensive new specialty drugs came to market and existing specialty drugs saw prices increase. T
Recent analysis of data from BCBS companies, the largest commercial claims database in healthcare, confirms this broader trend. BCBS companies’ data reveal that prescription drug per-member per-month spend increased by 9.3% from 2013 to 2014. This growth outpaced even the substantial rise in outpatient costs, and it far exceeded growth in inpatient and other professional costs. More importantly, this rise in pharmaceutical spend also runs counter to other trends, such as greater use of less-expensive generic drugs. For example, in 2014, consumers chose generic drugs 67.7% of the time when a branded counterpart was available versus just over half (54.9%) of the time in 2012.
The driving factor behind the pharmaceutical cost trend is the cost of specialty drugs, BCBS concluded. Data confirm that in 2014, specialty drug unit costs jumped 20.1%, compared to 5.7% for non-specialty drugs. Utilization for specialty drugs also rose by 7.3% in 2014.
Within the specialty pharmaceutical portfolio, the top 10 drugs contributed to 61% of overall spend. New Hepatitis C and Multiple Sclerosis drugs have contributed significantly to the trend, such as Sovaldi, a Hepatitis C treatment introduced in October 2014 that was priced at $84,000 for 12 week treatment, and Tecfidera for Multiple Sclerosis was priced at $55,000 for a 1 year treatment.
Macro trends, such as increasingly complex manufacturing processes and extended patent life, point to continued high unit costs for these drugs in the coming years, BCBS suggested. As a result, specialty drugs’ 23% current share of total prescription spend can only be expected to rise.
In response, BCBS Plans are actively implementing programs that make specialty drugs more affordable and that improve quality outcomes for members based on clinically-proven evidence, including:
Developing drug lists (i.e. formularies) and benefit designs, encompassing both medical and prescription benefit programs, that inform members of their treatment and medication options and the most appropriate drugs based on quality outcomes;Guiding patients to higher-quality, lower-cost healthcare providers; andPartnering with pharmacy benefit management companies focused on care coordination and medication management (e.g., appropriate usage, dosage and maintenance of specialty drugs).