Drug Costs Top $50K A Year For Half Million Americans
With the drug industry launching more expensive targeted therapies, the number of Americans with annual medication costs of more than $50,000 has jumped more than 60% to nearly 600,000, a new analysis shows.
The latest drug spending trend report from pharmacy benefit manager Express Scripts (ESRX) shows 576,000 Americans with annual medication costs of $50,000 or more. That’s a 63% increase in 2014 from 2013 when 352,000 Americans had such high costs.
While the number of patients with annual spending above $50,000 was just 0.2% of patients, the amount of drugs they and their health plans or employers paid for accounted for 16% of total spending, the analysis showed.
“The profile emerging from this research shows these patients are overwhelmingly taking specialty medications, and have multiple comorbidities, prescriptions and prescribers,” Dr. Glen Stettin, ExpressScripts’ senior vice president of clinical research and new solutions, said in a statement accompanying the analysis.
Express Scripts certainly has a vested interest in issuing such an analysis as a pharmacy benefit management (PBM) company, hired by some of the nation’s largest employers to reign in prescription costs.
The costs are putting a spotlight on PBMs, which include companies like Express Scripts and the Caremark subsidiary of CVS Health (CVS) as well as UnitedHealth Group’s Optum Rx Corp., which is buying pharmacy benefit manager Catamaran (CTRX) for $12.8 billion. PBMs are the middlemen between drug manufacturers and employers when it comes to purchasing pharmaceuticals and some see them potentially consolidating into even bigger players to wrest control of prescription prices.
Costs are increasingly driven by the latest biologic medicines, which are hailed for their effectiveness, but jeered for their high costs. Chief among them are pills for hepatitis C that cost $1,000 or more each and are sold by Gilead Sciences (GILD) and Abbvie (ABBV).
To combat these high costs, PBMs have been negotiating exclusive deals with hepatitis C pill makers. The PBMs essentially agree as part of the discount to provide their health plan members with coverage of one drug over the other. That brings the costs of the pills down.
But the discounts can only do so much as the size of the nation’s tab for prescription medicines climbs to new heights. Express Scripts said the number of patients taking at least $100,000 worth of medications almost tripled to 139,000 people in 2014 compared to nearly 47,000 in 2013.
Express Scripts said its analysis looked at prescription drug claims from more than 31 million Americans in 2013 and 2014. The population examined included Americans covered by commercial insurance as well as Medicare and Medicaid.
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Source: Forbes
