Drug Trend Report Shows Decline in Out-of-Pocket Costs


Express Scripts 2016 Drug Trend Report shows improvement in drug pricing.

Express Scripts’ annual Drug Trend Report showed the company restricted prescription drug spending to 3.8% last year, which is a 27% decrease from 2015.

Between 2015 and 2016, nearly 50% of employers who used Express Scripts to manage their benefits experienced an increase in per-person spending of less than 3.7%, and one-third experienced decreased pharmacy spending, according to the report.

Express Scripts customers experienced a drug spending increase of 2.6%, which is dramatically lower compared with other managed plans, according to the release.

Importantly, patients experienced less out-of-pocket costs, even if they were utilizing more prescription drugs. In 2016, patients paid 14.6% of the total cost of prescription drugs, which was slightly lower than the 14.8% rate from the previous year. Patients only paid an average of $0.10 more for their prescriptions in 2016, compared with 2015, according to the trend report.

Express Scripts’ commercial plans only saw a 2.5% increase in costs for prescription drugs, down 22% from 2015. These costs represented a more than 60% reduction in prices reported by manufacturers, Express Scripts reported.

"Rebates do not raise drug prices, drug makers do," said Glen Stettin, MD, chief innovation officer at Express Scripts in a press release. "As demonstrated by lower overall and unit cost trend in 2016, Express Scripts is effective in protecting employers from the effects of inflation by using our focused size and scale to secure significant rebates, which are returned to employers to reduce the overall cost of their pharmacy benefit."

Additionally, Express Scripts helped curb increases on costly specialty drugs. In 2016, specialty drug spending only increased 13.3%, which was said to be the lowest in trend report history. Overall, these drugs accounted for more than one-third of spending last year.

Inflammatory biologic drugs and diabetes treatments remained the costliest medications, with $1 out of every $5 dollars spent on the conditions in 2016, according to Express Scripts.

On average, employers paid $3587.83 per prescription for inflammatory conditions, such as rheumatoid arthritis (RA). While there are more than 15 different drugs to treat RA, Humira (adalimumab) and Enbrel (etanercept) accounted for 70% of the market, with cost increases between 10% and 18% in 2016. Biosimilars have the potential to drive down this spending, but delays in availability have not lead to significant decreases, according to the report.

Diabetes spending increased 19.4%, which was driven by a 14.1% increase in unit costs in 2016, according to the trend report. In particular, insulin spending, which accounts for 40% of diabetes treatment costs, increased 10%. On average, Express Scripts patients spent only $1.63 more for insulin in 2016 compared with 2015.

Spending on oncology drugs skyrocketed 22%, and despite the availability of generics, the costs of oral oncolytics increased by nearly 10%. List prices for these drugs have doubled since 2011, which has been a large driver of spending.

"The trends observed in these three leading therapy classes demonstrate the need for our industry leading SafeGuardRx solutions," Dr Stettin said. "Recent enhancements to our Oncology Care Value Program, and the launches of our Inflammatory Conditions and Diabetes Care Value programs, will help employers better manage spending in these areas through novel, indication-based reimbursement approaches, inflation protection and distinctive clinical care that has proven success with improving patient outcomes.”

Express Scripts also found that contraceptives and depression treatments were among the top 15 classes of drugs contributing to spending, which was attributed to increased utilization.

The PBM’s 2016 formulary was able to preserve access to clinically appropriate medications, and save $1.3 billion from manufacturers who understood that high prices would lead to the elimination of their drug, according to Express Scripts. Their 2017 formulary is expected to save an additional $1.8 billion.

"Express Scripts is a valued partner in our effort to make prescription drugs more affordable yet still accessible for our patients. Our recently implemented 'value' network, is a great example of an innovative way they are helping us achieve our goals," Johanna Melendez, AVP of Pharmacy, EmblemHealth, said in a press release.

Spending on hepatitis C virus (HCV) drugs in 2016 decreased by 34% due to lower costs and decreased use. Viekira Pak (ombitasvir/paritaprevir/ritonavir with dasabuvir) and Harvoni (ledipasvir/sofosbuvir) accounted for 43% of HCV spending, making them the most used drugs.

Express Scripts estimates that spending on HCV drugs will decrease nearly 30% each year between 2017 and 2019.

"In a year where the issue of high drug prices was No. 1 on the list of payer and policy maker concerns, the data show that our solutions protected our clients and patients," Dr Stettin said. "By practicing pharmacy smarter, we uniquely make medicine more affordable and accessible for patients. We do this by driving down drug prices and ensuring appropriate use of clinically-proven medicine, while helping employers remain competitive."

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