Fighting Back Against Irresponsible Drug Prices

By Express Scripts, Special for  USDR

Express Scripts’ (NASDAQ: ESRX) efforts to put medicine within reach for payers and patients effectively held the 2016 growth rate in prescription drug spending to just 3.8 percent – a 27 percent decrease from 2015 – according to the 21st edition of its annual Drug Trend  Report.

“In a year where the issue of high drug prices was No. 1 on the list of payer and policy maker concerns, the data show that our solutions protected our clients and patients,” said Glen Stettin, M.D., Chief Innovation Officer at Express Scripts. “By practicing pharmacy smarter, we uniquely make medicine more affordable and accessible for patients. We do this by driving down drug prices and ensuring appropriate use of clinically-proven medicine, while helping employers remain  competitive.”

Between 2015 and 2016, nearly half of employers whose pharmacy benefits were managed by Express Scripts saw a year-over-year increase in per-person spending of less than 3.7 percent, and one-third of employers had a decrease in pharmacy  spending.

Express Scripts programs ensure patient access, minimize waste and maximize savings. On average, employers who managed their pharmacy benefits more tightly with these programs held their 2016 increase in drug spending to 2.6 percent – significantly lower than less tightly managed pharmacy plans. If all pharmacy plans across the country tightly managed their benefit, the United States could have saved an additional $5.8 billion on prescription drugs last year, while maintaining a clinically sound and affordable pharmacy benefit for American  patients.

For the second consecutive year, patients of pharmacy plans managed by Express Scripts saw their total share of pharmacy costs decrease, despite using more prescriptions. Patients paid 14.6 percent of the total cost of a prescription medication in 2016, compared to 14.8 percent in 2015, as plan management programs enabled many employers to hold the line on copayments and deductibles. The average patient out-of-pocket cost for a 30-day prescription was $11.34 in 2016, roughly a dime more than in  2015.

Effectively Combatting Price  Inflation

Commercial plans managed by Express Scripts experienced only a 2.5 percent increase in unit costs across all prescription medications – nearly 22 percent lower than 2015, and more than 60 percent lower than the increase in prices, net of rebates, recently reported by major drug  makers.

“Rebates do not raise drug prices, drug makers do,” said Dr. Stettin. “As demonstrated by lower overall and unit cost trend in 2016, Express Scripts is effective in protecting employers from the effects of inflation by using our focused size and scale to secure significant rebates, which are returned to employers to reduce the overall cost of their pharmacy  benefit.”

Express Scripts’ Prescription Price Index shows continued inflation in the price of medications, with the average list price of the most commonly used brand drugs increasing nearly 11 percent in 2016. From the base price of $100.00 set in January 2008, in December 2016 prices for the most commonly used brand medications increased to $307.86 (in 2008 dollars), a nearly 208 percent increase. In contrast, price inflation for the most commonly used household goods is just 14 percent between 2008 and  2016.

Prices for the most commonly used generic medications declined 8.7 percent in  2016.

Bending the Curve on Specialty Drug  Spending

Express Scripts solutions helped to keep the increase in specialty drug spending to 13.3 percent in 2016 – the lowest trend reported since we first included specialty medications in our annual analysis in 2003 – and significantly less than the 17.8 percent trend in 2015. Specialty drugs accounted for more than a third of total spending in  2016.

Medications that treat inflammatory conditions and diabetes remain the costliest therapy classes. One of every five dollars spent on prescription drugs was for medication to treat an inflammatory condition or  diabetes.

Employers paid, on average, $3587.83 per prescription for a medication to treat an inflammatory condition, such as rheumatoid arthritis. Humira® (adalimumab) and Enbrel® (etanercept) were major trend drivers for the class, with unit cost increases between 10 and 18 percent. Despite having more than 15 available therapies in the class, these two medications accounted for approximately 70 percent of the market share in 2016. Biosimilar competition in this class could significantly ease spending for employers; however delays in biosimilar availability have limited payers’ ability to achieve much  relief.

Spending on diabetes medications increased 19.4 percent in 2016, driven by a 14.1 percent increase in unit cost. Total spending on insulins — which account for 40 percent of all diabetes spending — increased nearly 10 percent between 2015 and 2016. The average patient out-of-pocket cost for insulin was $36.69 per prescription (adjusted for difference in days’ supply), just $1.63 more than  2015.

In 2016, spending on oncology medications increased nearly 22 percent, making it the third-costliest class. Despite savings from generics, including imatinib, the generic for Gleevec®, unit costs for oral oncology medications increased 9.6 percent in 2016. List prices for oral oncology medications, which are not rebated or discounted to any significant extent, have doubled between 2011 and 2016, from $20 per unit to $40 per  unit.

“The trends observed in these three leading therapy classes demonstrate the need for our industry leading SafeGuardRx solutions,” said Dr. Stettin. “Recent enhancements to our Oncology Care Value Program, and the launches of our Inflammatory Conditions and Diabetes Care Value programs, will help employers better manage spending in these areas through novel, indication-based reimbursement approaches, inflation protection and distinctive clinical care that has proven success with improving patient  outcomes.”

Other noteworthy  trends:

  • Compound Medications: Plans that implemented Express Scripts’ safeguards against unnecessary and potentially unsafe use of compounded medications in 2015 and 2016 saved $2 billion and eliminated 95 percent of spending for the class.
  • Pain Medications: One in five people filled a prescription for a pain medication in 2016. Despite a 95 percent generic fill rate for this class of drugs, spending was driven by just two brand-name medications: Lyrica® (pregabalin) and OxyContin® (oxycodone). Pain medications are the fifth costliest class of drugs.
  • In 2016, contraceptives and medications for depression entered the top 15 classes of drugs driving spending. Increased utilization for both classes contributed most to the increased spending.

Savings and  Access

In 2016, the Express Scripts National Preferred Formulary® preserved patient access to medication while saving plans $1.3 billion from drug manufacturers who understand that in the absence of competitive pricing, their drugs may be excluded from coverage under clients’ plans. Of approximately 4,000 available drugs, the NPF excluded just 80 drugs in 2016, meaning that 99.5 percent of patients in plans using the Express Scripts National Preferred Formulary had no change in their covered medication. The Express Scripts National Preferred Formulary is projected to deliver an additional $1.8 billion in savings in 2017, for a cumulative savings of $4.9 billion since  2014.

“Express Scripts is a valued partner in our effort to make prescription drugs more affordable yet still accessible for our patients. Our recently implemented ‘value’ network, is a great example of an innovative way they are helping us achieve our goals,” said Johanna Melendez, AVP of Pharmacy,  EmblemHealth.

Delivering Value  Beyond

In 2016, spending for hepatitis C medications decreased 34 percent due to decreased unit costs and use. Viekira Pak™ (ombitasvir/paritaprevir/ritonavir with dasabuvir) and Harvoni® (ledipasvir/sofosbuvir) remained the two most-utilized therapies, capturing 43 percent of the market share. However, additional competition resulted in a unit cost decline of 6.7 percent in the  class.

Spending for the hepatitis C therapy class is forecast to decline an average 28.8 percent annually between 2017 and  2019.

This year, our Hepatitis Cure Value Program® includes both Viekira Pak/XR and Harvoni as preferred products, leveraging the success of the program to negotiate better pricing for Harvoni and expand treatment options for patients and physicians in  2017.

Since this program began in 2015, we’ve helped more than 50,000 patients gain access to curative therapy across the Express Scripts customer base, while continuing to lower the cost of treatment by nearly 50 percent and delivering a cure rate greater than 95  percent.

The Express Scripts 2016 Drug Trend Report offers the industry’s most comprehensive review of trends in prescription drug spending for commercially insured plans. To access the full report, please visit

About Express  Scripts

Express Scripts puts medicine within reach of tens of millions of people by aligning with plan sponsors, taking bold action and delivering patient-centered care 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, specialty benefit management, 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.

SOURCE Express  Scripts

All opinions expressed on USDR are those of the author and not necessarily those of US Daily Review.