Prime Therapeutics' Prescription Drug Costs Climbed 2.1% in 2012

The 2.1% increase in total prescription drug costs in 2012 was driven by a 19.1% increase in specialty drug costs.

Prescription drug costs increased 2.1% in 2012 among Prime Therapeutics’ members, according to the pharmacy benefit manager’s annual Drug Trend Insights. The 2.1% increase was driven by a 19.1% increase in specialty drug costs and offset by a 0.9% drop in traditional drug costs for Prime Therapeutics’ members.

“For nearly a decade we’ve achieved single digit drug trend, and one of the lowest trends in the industry,” said Eric Elliott, Prime president and chief executive officer. “Helping members find the most effective treatments, remain on their medications, and aggressively negotiating drug pricing has helped us keep costs low for members and plan sponsors.”

Prime’s drug trend number is an indication of how effective its efforts to manage costs and make medicines more affordable were over the past year. While pharmaceutical costs are increasing at rates higher than inflation, Prime’s efforts helped keep costs about $36 lower for every pharmacy plan member last year than they might otherwise have been. Prime achieved these savings by helping members find the most cost effective treatments, offering programs to guide proper drug use. In addition, Prime negotiated lower rates and dispensing fees with pharmacies as well as discounts and rebates with manufacturers.

Three leading factors drove the changes in spending over the past year:

  • Greater use of prescriptions: Use of prescription drugs climbed 0.7%, to an average of 13 prescriptions per member, per year. High blood pressure medications were the most commonly prescribed class of drugs, accounting for 17% of prescriptions.
  • Higher prices: Drug costs increased 6.4% overall due to inflation alone, while the top 5 drug categories taken by members saw price inflation of more than 9% last year. Drugs to treat multiple sclerosis and attention deficit hyperactivity disorder were among those with the highest levels of price inflation, at 19.8% and 15.7% respectively. Others categories included autoimmune (10.6%), diabetes (10.2%) and oral cancer (9%).
  • Increased use of generics: A greater percent of members switched from high-cost brand name drugs to lower cost generics last year, helping pull down spending by 4.6%. Prime’s generic fill rate reached 78.8%.

“In recent years, the increasing use of generic drugs and the number of brand-name drugs going generic has helped keep costs down,” said Peter Wickersham, Prime’s senior vice president of cost of care. “We’re reaching the peak for generics, and over the next few years we won’t be able to rely on generics to lower drug costs. This, combined with the increasing use of high-cost specialty drugs, will likely result in greater overall spending in the future.”

Adapted from Prime Therapeutic's

2013 Drug Trend Insights

infographic

The number of Americans with chronic disease continues to grow, and many rapidly rising conditions — such as autoimmune disorders, multiple sclerosis, and cancer – are treated with specialty medications. Use of specialty drugs increased 4.8% in the past year.

At the same time, these medications saw price increases at 10 times the rate of inflation. Specialty drugs typically cost 50 times more than a traditional drug. When specialty drugs are excluded from overall spending, per member costs actually dropped 0.9% last year.

Specialty drugs are expected to push overall drug spend to double digits over the next few years. As specialty spending rises, Prime will continue to deliver superior cost management on behalf of its clients and members. Prime’s focus has been, and will always be, to provide the highest quality of care while keeping costs low.

The infographic is the first release in Prime’s 2013 Drug Trend Insights series. A report on specialty drugs will be released later in the year.

About Prime Therapeutics

Prime Therapeutics LLC (Prime) helps people get the medicine they need to feel better and live well. Prime manages pharmacy benefits for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and delivers medicine to members, offering clinical services for people with complex medical conditions. Headquartered in St. Paul, Minn., Prime serves more than 21 million* people. It is collectively owned by 13 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. Prime has been recognized as one of the fastest-growing private companies in the nation.

*Effective July 1, 2013

SOURCE: Prime