Specialty Drug Spending Triples Since 2003

Although specialty drugs account for only a small portion of total prescriptions filled, they have dramatically increased the total prescription drug spend.

A study from the University of North Carolina at Chapel Hill discovered that specialty medications comprised just 1.8% of drugs prescribed in 2014, yet accounted for 43.2% of total drug spending.

“There’s a story here of very expensive drugs used by relatively small groups of patients for conditions for which there are few options,” said lead researcher Stacie Dusetzina. “But we also have commonly used drugs for which there might be acceptable substitutes being prescribed for very large groups of patients.”

In 2003, specialty drugs accounted for 11% of the total money spent by commercial health plans on prescription drugs received at pharmacies, but by 2014 they comprised more than 43%.

In the study, Dusetzina reviewed prescriptions from patients enrolled in commercial insurance plans from 2003 to 2014. She used the Truven Health MarketScan Commercial Database to explore trends in the prescribing of specialty drugs.

A specialty drug was defined in the study as a product that costs $600 or more for a 30-day supply. This is the threshold the US Centers for Medicare and Medicaid Services (CMS) allows for a product to be put on a specialty tier.

Each cost was adjusted to represent 2014 dollars in order to account for inflation.

The results of the study showed that specialty drug use tripled between 2003 and 2014, increasing from 0.6% of all prescriptions to 1.8% in 2014. The spend on specialty drugs by commercial health plans also tripled over the same time period.

The findings revealed the amount of unique products that met the $600 per month threshold increased from 3% in 2003 to almost 12% in 2014.

Humira, followed by Enbrel and Sovaldi, were the top 3 prescription drugs that contributed to 2014 commercial health plan spending. Furthermore, Sovaldi was found to be the most expensive drug per fill in 2014, at $28,083.

Treatments for diabetes, high cholesterol, pain, and attention deficit hyperactivity disorder also contributed to the spending jump, mostly due to the high number of prescriptions for them, according to the study.

Additionally, Dusetzina also examined how much patients paid for drugs over time. She found that out-of-pocket spending dropped for patients using lower-priced non-specialty drugs, and increased for specialty drugs.

The average cost out-of-pocket for non-specialty drug prescription fills decreased from $19 to $11 per month over the course of the study period, while out-of-pocket spend increased for specialty drugs from $41 to $77 per month. Dusetzina noted that spending could be reduced by increasing the use of generic drugs instead of brand names and implementing more value-based care models.

“Prescription drug spending in the United States will likely continue to increase, as payers grapple with providing coverage for important and expensive therapies,” Dusetzina said.