Top 10 Specialty Drug Therapeutic Classes


Multiple sclerosis, oncology, and inflammatory conditions among the top drivers of specialty pharmacy spending in annual Express Scripts trend report.

In 2015, specialty medications accounted for 37.7% of total drug spending and a 17.8% overall trend, according to the annual Express Scripts Drug Trend Report.

The report analyzes US prescription medication costs and utilization, with marketplace factors that impact future changes. All of the top 10 specialty therapy classes increased in spend and in the unit cost of medications.

The top 3 specialty therapy classes, which includes multiple sclerosis, oncology, and inflammatory conditions, accounted for 56.3% of all specialty spend.

Below are the top 10 specialty therapy classes for 2015:

10. Sleep disorders

Despite low market share, this class was able to make the top 10 specialty medications easily due to the average cost per prescription of about $9000. The PMPY spend increased by 24.1%, which was influenced by an 18.5% increase in cost and 5.5% increase in utilization.

Currently, sodium oxybate (Xyrem) and tasimelteon (Hetlioz) account for 100% of the market share in this class.

9. Hemophilia

There was a 15.4% increase in unit cost, which contributed to the rise in spend for 2015. Brand inflation for antihemophilic and clotting drugs, such as antihemophilic factor (recombinant) (Eloctate), which had a triple digit utilization and unit cost increases, also contributed to the increase. This particular class has a small market share and a high average cost of therapy, so even a small utilization increase can have a large impact on overall spend.

8. Pulmonary hypertension

The 13.4% utilization increase and 4.8% unit cost increase were responsible for the increased trend by 18.1% in 2015. Utilization increased for 7 of the 10 top drugs in spend for this class. Sildenafil is still the most prescribed drug in the class, accounting for 36.4% of the market share. The drugs treprostinil (Orenitram), macitentan (Opsumit), and rociguat (Adempas) increased in utilization by 315.8%, 111.2%, and 72.3%, respectively. Orenitram decreased by 53.2% in unit cost, which most likely played a role in the increased utilization.

7. Cystic fibrosis

The trend for this class of medications reached 53.4% in 2015. This class only consists of 10 drugs with an average cost per prescription of $6,441.27. One of the 2 most costly drugs for cystic fibrosis approved in mid-2015 is lumacaftor/ivacaftor (Orkambi), which helped drive the trend.

6. Growth deficiency

The trend for rare condition growth deficiency was 5.6% as a result of equal trend in utilization and unit cost (2.8%). For the fourth consecutive year, somatropin (Norditropin, Flexural) dominated the class and accounted for 49.1% of market share. Norditropin is the highest spend within the class and increased in unit cost and utilization by almost 11%. The second drug in spend is somatropin (Genotropin), but the trend decreased by 12%, which was largely in part to an 11.3% decrease in unit price. The highest trend in 2015 was mecasermin (Increlex), which had an overall increase in spend of 140.6% because of a 126.8% increase in utilization.

5. HIV

Brand inflation and utilization drove the trend for HIV drugs, with 6 of the top drugs increasing in spend by double and triple digits in 2015. There was a 4.6% increase in utilization and a 12% unit cost increase, which contributed to the overall 2015 trend increase of 16.6% in PMPY spend, which moved it up to fifth place in the most expensive specialty therapy class.

4. Hepatitis C

In 2014, there was a record increase in spend because of new and effective oral antiviral therapies with an expensive price tag. However, the 2015 trend was lower with a spend increase of 7%. Utilization decreased 2.2%, while there was a 9.2% increase in unit cost that was responsible for driving a majority of the change in spend.

Viekira Pak and Harvoni, which were approved in 2014, accounted for more than 57% of market share for hepatitis therapy.

3. Oncology

The FDA approved 10 oncology therapies in 2015, which helped increase spend 23.7%, while the increase in utilization (9.3%) and unit cost (14.4%) helped drive the trend. The oncology treatment Gleevec and lenalidomide (Revlimid) account for more than 22% of the market share, with Gleevec comprising the largest market share at an increase in unit cost by 19.3%.

2. Multiple sclerosis

MS ranked at number 2 in total trend for medications at 9.7%. The increase found in unit cost (6.2%) and utilization (3.5%) helped drive the total trend. The overall trend was especially influenced by the increase in unit price of the top 5 most prescribed medications, which accounted for 84% of the spend. The unit cost increase for MS drugs was between 3.8% and 9.4%, with glatiramer (Copaxone) being the most widely used and having the highest spend in the class, but a generic version was launched in June 2015.

1. Inflammatory conditions

When ranked by per member per month (PMPY) spend, inflammatory conditions remained at the top of specialty therapy classes for the seventh consecutive year, trending at 25%. Most of the top drugs within the class are disease modifying anti-rheumatic drugs (DMARDs) responsible for treating psoriasis, rheumatoid arthritis, inflammatory bowel disease, and other conditions as well.

Additionally, the top 2 drugs adalimumab (Humira) and etanercept (Enbrel) saw an increase in unit cost.

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