As more biosimilars and specialty generics enter the market next year, this could result in a shift in drug spending.
Pharmaceutical Strategies Group (PSG) released its Artemetrix State of Specialty Spend and Trend Report, which uses integrated pharmacy and medical claims data to formulate views on specialty spending and trends.
Inflammatory conditions continue to be the top category, with adalimumab (Humira; AbbVie) the top drug for overall plan cost, according to the report.
“Specialty trend returned to a pre-pandemic level in 2021, rebounding to 14.2%,” Michael Lonergan, RPh, president of PSG, said in a statement.
“However, it is encouraging to see competition from biosimilars impact cost, he said. “We saw an overall increase in utilization, from 12.4% in 2020 to 22.5% in 2021 and expect more meaningful impact as biosimilars for [Humira] enter the market next year.”
Claim utilizations continued to drive trends, similar to what was seen in 2020. Approximately 9.4% of the 14.2% of 2021 was the result of increased claim utilization, while 4.4% was because of changes in cost per claim.
Although high-cost therapies are at the forefront, utilization is driving specialty trends, investigators said.
Investigators think that as costly new therapies for higher prevalence disease enter the market, such as those for asthma and migraines, the trend will likely continue.
However, the investigators estimate that as biosimilars and specialty generics enter the market next year, this could result in a shift.
Additionally, investigators found that the percentage of specialty spending in the medical industry compared with pharmacy benefit is 35.5% to 64.5%, respectively, which reflects percentages from 2016.
“While the definition of what comprises specialty drugs has shifted since the inception of this report 6 years ago, the importance of proactive specialty drug program management has not changed. “Our data supplies the needed precision to track trend drivers and keep pace with the rapidly changing market complexities, allowing for the construction of appropriate plan strategies,” Renee Rayburg, RPh, vice president of Specialty Clinical Consulting, said in the statement.
“Access to integrated data creates the ability to align PBM and health plan strategies to achieve the maximum financial benefit,” she said.
Specialty drug plan costs continue to grow, reaching an average of $1295 per member per year, which is approximately double the cost in 2016.
Likely related to the pandemic, the trend reduced to 11.8% between 2019 and 2020 but rebounded to 14.2% between 2020 and 2021.
The percentage of the population that used at least 1 specialty drug increased to 5.9% in 2021, after stabilizing at 4.8% between 2019 and 2020.
“The Artemetrx Specialty Spend and Trend report is an important tool to aide in the assessment and design of specialty pharmacy strategy,” Timothy Carroll, PharmD, vice president of Business Development and Analytics at Reliance Rx, said in a statement. “It becomes more essential as new therapies, generics and biosimilars are introduced and paradigms are continually shifting.”
The report continues to inform payers and sponsors on opportunities and decisions in the future.
Proprietary State of Specialty Spend and Trend Report released by Pharmaceutical Strategies Group. News release. Pharmaceuticals Strategies Group. August 23, 2022. Accessed August 23, 2022. Email.