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Express Scripts Study Reveals Keys to Controlling Specialty Drug Costs
Date:3/7/2013

who are members of NBGH, representing more than 5 million Americans with pharmacy benefits. The employers were categorized into one of three groups based on the type of cost management programs adopted:

  • Unmanaged — employers whose health plan members could obtain their specialty medications from any pharmacy and did not use any specialty utilization management programs
  • Somewhat managed — employers whose health plan members used a specialty pharmacy exclusively and one specialty utilization management program
  • Tightly managed — consisting of employers whose health plan members used a specialty pharmacy exclusively combined with multiple specialty utilization management programs

Employers classified as unmanaged experienced an annual average increase in specialty drug spending per member per year of 27.8 percent. However, employers classified as tightly managed saw an annual increase in specialty drug spending per member per year of 13.6 percent, half that of the unmanaged group and nearly one-third lower than the average annual projected specialty drug trend. In addition, tightly managed programs saw higher average member adherence rates in top therapy classes such as multiple sclerosis and oncology.

Specialty Medications Require Specialized Management Solutions

According to the Express Scripts 2012 Drug Trend Report, the increase in spending on specialty drugs in 2012 was 18.4 percent, up slightly from 2011, which was 17.1 percent. Spending on traditional medications decreased for the first time to -1.5 percent, predominantly due to generics. Driving specialty medication trend in the top 10 therapy classes was unit costs, up 18.7 percent, while utilization was -0.4 percent. Specialty medications for inflammatory conditions, multiple sclerosis, cancer and HIV accounted for nearly 70 percent of annual spending on specialty drugs.
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SOURCE Express Scripts
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