A new study by Prime Therapeutics has shown a sharp increase in the number of drug "super spenders," defined by the researchers as members with pharmacy and medical drug therapy claims of $250,000 or more annually. The researchers used predictive analytics to identify this consumer group, in an effort to better identify savings opportunities and create optimal care strategies to meet patients' needs and control costs.

The study found that approximately 5000 drug super spenders incur $250,000 or more in annual prescription expenses and account for more than $2 billion in health plan drug costs as of 2018. To identify this group, Prime examined all members in a large, commercially insured population with any period of enrollment between January 2016 and December 2018.

Not only is a small portion of members accounting for a large amount of drug spend, but that group of patients is growing.

The researchers found that in 2016, there were 2994 members accounting for $1.324 billion in drug spend or 6.3% of total drug spend. By 2018, however, there was a 63% increase in the number of super spenders with 4869 members accounting for $2.119 billion in drug spend or 8.6% of the total. This also amounted to a 60% increase in super spenders' costs. The researchers forecasted a drug super spend cost of over $4 billion in 5 years.

Specialty drugs, now totaling over 50% of total drug spend, are a large cause for this increase. Between 2013 and 2016, per capita drug spending on specialty drugs increased by 55%, according to IQVIA's Medicine Use and Spending Report. While the innovations of specialty drugs can be vital in treating rare or complicated diseases, the drugs can cost anywhere from $500,000 to over $2 million.

Cancer condition categories accounted for 48% of the total increase between 2016 and 2018, while inherited single gene disorders accounted for 31%.

The study had several limitations, most notably that its findings cannot be extrapolated to populations such as Medicare and Medicaid, and may differ from other commercially insured populations with different attributes. Additionally, many of the individual conditions described in the study are too rare to accurately estimate prevalence.

Finally, they noted that extremely high drug expenses for an individual can result from many factors. High manufacturer prices are a common factor, and some contractual agreements can also lead to high drug prices.

The researchers concluded their report by recommending several drug cost management strategies for health plans to anticipate, track, and optimize specialty drug and one-time therapy for drug super spenders. In order to better manage the costs, they emphasized the importance of integrating medical and pharmacy benefit analytics, predictive modeling, and clinical expertise. These aspects can also be combined with case management, innovative manufacturer contracting, and waste and abuse capabilities.


REFERENCE

Bowen K, Gleason PP. Drug Super Spenders: 2016 to 2018 Growth in Number of Members and Total Pharmacy Plus Medical Benefit Drug Cost for Members with Extremely High Annual Drug Cost in a 17 Million Member Commercially Insured Population. Primetherapeutics website. https://www.primetherapeutics.com/content/dam/corporate/Documents/Newsroom/Pressreleases/2019/document-amcpposter-superspenders.pdf. Published October 2019. Accessed October 7, 2019.