DRUG SPENDING FOR 2016

Biologic anti-inflammatory drugs, diabetes medications, and cancer therapies were the top three categories of pharmaceutical spending in 2016 by employers who used the pharmaceutical benefit management (PBM) company Express Scripts.

One of every five dollars spent on prescription drugs was for a medication to treat an inflammatory condition or diabetes, according to the PBM's 2016 Drug Trend Report. St. Louis-based Express Scripts is the nation's largest PBM, serving some 85 million Americans.

The company said it kept drug costs down for its clients through its various programs, though prices still increased. Average list prices for the most commonly used brand-name drugs increased 10.7% in 2016. Specialty drug costs continued to rise — 6.2% in 2016. Prices for the most commonly used generic drugs declined by 8.7%.

Certain individual drug categories continued to hit purchasers hard. Express Scripts' employer clients paid almost $3,600 on average per prescription for an anti-inflammatory condition such as psoriasis or rheumatoid arthritis. Two brand names — Humira(adalimumab, AbbVie) and Enbrel (etanercept, Amgen) — were the biggest cost drivers in the class, with unit cost increases of 10% to 18%. The two therapies accounted for 70% of the anti-inflammatory market, despite there being 13 other available therapies, according to the PBM.

Spending on diabetes medications increased 19.4%, largely fueled by a 14% increase in unit cost. Express Scripts said that spending on insulins — which accounted for 40% of all diabetes spending — increased 10% from 2015 to 2016. Clients of the PBM paid $36.69 per insulin prescription, which was $1.63 more than 2015.

Oncology drug spending rose 22% in 2016, in part because unit costs for oral therapies increased by almost 10%. Express Scripts noted that oral chemotherapies are not subject to rebates or discounts "to any significant extent," and that, since 2011, list prices for those medications have doubled from $20 per unit to $40 per unit.

Pain medications were the fifth costliest class of drugs for employers (after multiple sclerosis medications), with one in five of the PBM's enrolees filling a prescription in 2016. Ninety-five percent of the prescriptions were for a generic. Even so, two brand-name medications helped drive costs up — Lyrica (pregabalin) and OxyContin (oxycodone).

Express Scripts also reported an uptick in spending on contraceptives and depression medications, bringing those two classes into the top 15 for drug spending for the first time. The Affordable Care Act (ACA) requires private plans on the exchanges and Medicaid programs to provide contraceptives free of charge. Insurance plans created after 2012 had the same requirement.

The ACA also required coverage of mental health services for exchange plans, Medicaid, and so-called nongrandfathered employer-based health plans.

Express Scripts reported a 34% decrease in spending on hepatitis C medications, which it said was due to decreased unit costs and less use. The two most-used therapies were Viekira Pak(ombitasvir/paritaprevir/ritonavir with dasabuvir) and Harvoni (ledipasvir/sofosbuvir), which accounted for just over 40% of the market.

The PBM said it expects hepatitis C spending to decline almost 29% each of the next 2 years, in part because it is negotiating better pricing forHarvoni. It is including both Viekira Pak/XR and Harvoni as preferred products on its formulary in 2017.