ST. LOUIS, Oct. 3, 2017 /PRNewswire/ -- A small but steadily
growing number of Americans account for an increasingly significant
amount of the nation's overall prescription drug bill, according to
new research released today by Express Scripts (NASDAQ: ESRX).
The latest edition of the company's report, Super Spending:
U.S. Trends in High-Cost Medication Use, examines trends for
people with commercial, Medicare, Medicaid and Health Insurance
Exchange coverage who had annual medication costs at or exceeding
$50,000 in 2016.
Between 2014 and 2016, the number of people representing annual
medication costs of $50,000 or
greater increased by 35 percent. In 2016, about 3 out of every
1,000 people in the analysis accounted for more than 20 percent of
total pharmacy spending. Extrapolating these data to the U.S.
population, an estimated 870,000 Americans accounted for
$80 billion of 2016 U.S. pharmacy
spend.
Prescription drug
cost
category
|
Percent increase
in population
2014-2016
|
$50,000-$99,999
|
40%
|
$100,000-$199,999
|
36%
|
$200,000-$499,999
|
56%
|
$500,000-$999,999
|
85%
|
$1
million+
|
100%
|
In contrast, nearly 83 percent of the people in the analysis
generated less than $1,000 in annual
drug costs in 2016, including 32 percent who had no drug costs at
all.
"At a fraction of a percent of all Americans, this population
may seem small. However, every person in America is on a first-name
basis with at least one other person – a relative, friend, or
colleague – who has annual drug costs that are nearly the same
amount as the median U.S. household income," said Glen Stettin, M.D., Senior Vice President,
Clinical, Research and New Solutions at Express Scripts.
This updated research also reveals a significant shift in what
is driving spending among the population of people with high annual
pharmacy costs. In 2014, compounded medications and new hepatitis C
therapies drove much of the spending among people with $50,000 or more in annual pharmacy costs. In
2016, through our leadership, the cost of hepatitis C therapies
declined and spending on compounded medications -- which have safer
and lower-cost alternatives – virtually disappeared from this
population, and treatments for cancer, multiple sclerosis,
inflammatory cystic fibrosis and other complex and rare diseases
emerged as the more prominent conditions in this population.
In 2016, more than a quarter of the medication costs for
patients reaching or exceeding the $50,000 threshold were for cancer treatments.
"The good news is much of the spending at these levels is
focused on treatments for rare and serious complex conditions with
limited treatment options," said Stettin. "As we help payers
effectively manage utilization and leverage competition, we create
the headroom necessary to afford more costly therapies, as we saw
with our commercial and Medicare plans that held year-over-year
drug spending to just 3.8 percent and 4.1 percent, respectively, in
2016.
"However, employers, insurers and government payers, who absorb
98 percent or more of the costs, still need relief when it comes
affording to care for this population. Lowering costs will require
new entrants in categories with limited competition, more
responsible pricing for these rare and complex therapies, and
potentially different reimbursement strategies."
Cost Sharing
People with annual pharmacy costs
exceeding $50,000 were four times as
common in Medicare than in an employer-sponsored, Medicaid or
Exchange plan, with eight out of every 1,000 Medicare beneficiaries
reaching that threshold in 2016.
Plans covered nearly 98 percent of the costs for people whose
prescription drug bills exceeded $50,000 in 2016, paying an average of
$89,308 per person. For this
population covered by Medicaid, 99.9 percent of the costs were
covered in 2016.
Payers shouldered the majority of the cost burden, and kept
members' total out-of-pocket cost share relatively flat. People
with $50,000 or more in drug costs
were responsible for 2.4 percent of their total 2016 pharmacy
costs. The average annual out-of-pocket cost for this population
was $2,156 in 2016, which may not
account for manufacturer or foundational payment assistance.
Breaking the Million Dollar Barrier
People with
$1 million or more in annual pharmacy
spend are no longer one in a million: the number of Americans
reaching that amount, while rare, doubled between 2014 and
2016.
Hereditary angioedema (HAE), a rare disorder characterized by
recurrent and often life-threatening episodes of severe swelling,
was the leading indication for treatment for people with
$1 million in annual pharmacy costs
in 2016, followed by enzyme deficiency disorders and hemophilia.
There are only six approved therapies to treat the approximately
6,500 people in the U.S. who have HAE, with the cost ranging from
$12,000 to $2 million per
treatment. Prior to the discovery of these medications,
one-third of people with HAE died of asphyxiation due to swelling
in their airways.
Super Spending Across Generations
Baby Boomers (people
aged 53 to 71) continued to account for nearly half of all
Americans with annual pharmacy costs at or exceeding $50,000 in 2016, followed by Generation X (people
aged 34 to 52), who accounted for a quarter of that population.
Oncology, multiple sclerosis, inflammatory conditions and hepatitis
C treatments are the leading spend drivers for both generations in
this high-cost population.
Millennials (people aged 14 to 33) accounted for 10 percent of
the population of Americans with $50,000 or more in annual pharmacy costs in
2016. The largest proportion of spend for this generation was
for medications that treat cystic fibrosis.
Oncology treatments dominated spending among the Greatest
Generation (people aged 73 or older), who had more than
$50,000 in annual pharmacy costs last
year.
About the report
The analysis examined the
de-identified prescription drug claims for more than 26 million
Americans with pharmacy coverage provided by an employer, Medicare,
Medicaid or Exchange plan, and managed by Express Scripts, between
2014 and 2016. The analysis looked at gross cost, which
includes both plan and patient out-of-pocket costs, after
rebates.
To review the full report, please visit
lab.express-scripts.com.
About Express Scripts
Express Scripts puts medicine
within reach by practicing pharmacy smarter – taking bold action,
delivering specialized care, creating innovative solutions and
leveraging data insights - to make better health more affordable
and accessible.
Headquartered in St. Louis,
Express Scripts provides integrated pharmacy benefit management
services, including network-pharmacy claims processing, home
delivery pharmacy care, specialty pharmacy care, benefit-design
consultation, drug utilization review, formulary management and
medical and drug data analysis services. Express Scripts also
distributes a full range of biopharmaceutical products and provides
extensive cost-management and patient-care services.
For more information, visit Lab.Express-Scripts.com or follow
@ExpressScripts on Twitter.
Media Contacts:
Jennifer
Luddy, Express Scripts,
908-794-9226,
Jennifer_Luddy@express-scripts.com
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SOURCE Express Scripts