BCBSA study: Specialty main driver of spending growth from 2013-2014

Spending on specialty pharmacy medication rose about 26% between 2013 and 2014, according to a new report on spending per member from the Blue Cross Blue Shield Association (BCBSA) and HealthCore. 

 

The report uses data on specialty drugs covered through both pharmacy and medical benefits, the latter of which can provide particular insight into changes in spending on cancer drugs — 80% of which are billed through the medical benefit. 

 

“The recent, rapid increases in specialty drug costs are a concern for everyone,” BCBSA chief medical officer Dr. Trent Haywood said. “To promote affordability and access to new innovative medicines, it’s important to have greater competition and choice to bring costs down for everyone, including speeding up the approval of generic and biosimilar drugs. There also should be transparency regarding the pricing of prescription medicines with information about price and a drug’s effectiveness made widely available to the public.”

 

The 26% increase in spending translated to an increased cost of $87 per member between 2013 and 2014, with $29 of that increase going to hepatitis treatments, $22 to medication for inflammatory conditions, $14 to cancer treatments, $9 to multiple sclerosis treatments, $8 to HIV treatment and $6 to other specialty categories. 

 

Additionally,  the increase in specialty drug costs was the main driver of spending growth during the time the study covers. And in the individual market, specialty drugs cost 17% more than in the employer market. In total among the BCBS members in the study, $14.6 billion was spent in 2013, rising to $18.4 billion in 2014, with 30% of the growth coming from cancer treatments. 

 

Given the costs associated with specialty medications — and the recent entry to the specialty market of two PCSK9 inhibitors, a pricey class of cholesterol drugs — BCBSA is hoping biosimilars, alongside more competition and a more efficient approval process will help cushion the financial blow. 

 

“Moving forward, the advent of biosimilar drugs may help cut costs in much the same way as generics,” the study says. “Blue Cross Blue Shield Association supports greater competition and choice to bring costs down for everyone, including speeding up the approval of generic and biosimilar drugs.”