According to the Express Scripts’ 2012 Drug Trend Report, four of the country’s 15 costliest diseases in drug spend are treated with specialty medications.  The report highlights key specialty therapy classes and ranks them due to per member per year (PMPY) spend.

Inflammatory conditions continue to lead in PMPY spend compared to other specialty therapeutic categories. Conditions such as rheumatoid arthritis (RA) fall under inflammatory conditions. According to the report, inflammatory conditions had a 9 percent increase in utilization and a 14 percent increase in costs, resulting in a total trend of 23 percent. With Xeljanz (tofacitinib) entering the market as the first oral disease modifying medication approved for RA, new and existing medication users may steer away from older injectable treatments. The report suggests that some of the cost increases for these older injectable treatments may have been caused by concerns over future declining market share as these new oral medications become available.

Multiple sclerosis comes in second with most PMPY spend for specialty therapies, with an increased utilization of 0.5 percent and a unit cost increase of 17.3 percent, with a total trend of 17.8 percent.

Cancer medications had an increase in utilization of 3.4 percent and an increase in cost of 22.3 percent resulting in a total trend of 25.8 percent. The report notes that much of the increase in cost is due to new drugs developed for treatment of unique genetic or proteomic profiles, which is a trend that has increased in recent years. Additional research is needed for developing targeted medications, which results in higher costs. Additionally, costs are increased by more patients initiating newer, more-expensive therapies as opposed to trying older oncology medications as first-line therapies.

HIV medications came in fourth highest PMPY spend in the specialty pharmaceutical therapeutic categories. Utilization of HIV medications decreased by 2.1 percent, however costs of medication increased by 11.1 percent resulting in a total increased trend of 9 percent in total spend. According to the report, this is due to patients switching from older, multi-pill regimens to more expensive combination therapies. Some of the multi-pill regimens are available as generics, so switching to the more-expensive combination therapies like Atripla and Truvada caused the increase in cost.

Hepatitis C ranked fifth in highest PMPY spend per year however continues to lead total trend for specialty drugs. The report showed that utilization increased by 28.9 percent and unit cost increased by 4.8 percent, resulting in a total increase trend of 33.7 percent. According to the report, the increased cost is due to the introduction of Incivek (telaprevir) and Victrelis (boceprevir) in May 2011.

To view the Express Scripts’ chart of the top 10 specialty pharmacy therapeutic classes of PMPY spend per year, click here.

Source: Express Scripts 2012 Drug Trend Report

Last updated: 3/5/13; 2:50AM EST