Drug Trend Report

The Express Scripts Drug Trend Report provides detailed analysis of U.S. prescription drug costs and utilization, as well as the marketplace factors that affect future changes.

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The Strength of Practicing Pharmacy Smarter

Responding to skyrocketing drug price inflation and premium-priced therapies for large patient populations, Express Scripts significantly controlled drug costs for our clients and improved care and access for our patients in 2015.

Working collaboratively with our clients, we kept the increase in drug spending to just 5.2% in 2015, roughly half the increase seen in 2014. More importantly, at a time when many plans around the country have been shifting more costs to patients via higher deductibles and out-of-pocket expenses, Express Scripts members’ average copayment decreased 3.2% last year.

Components of Trend

For more than 30% of Express Scripts clients, drug spending was flat or negative in 2015. In addition, Express Scripts clients implementing four or more cost-saving solutions, on average, held their 2015 increase in drug spend to 3.3% – nearly two percentage points lower than the national average. If all U.S. plans adopted similar strategies, national drug spend would have been reduced by $6 billion.

Managed Trend

Mitigating Inflation

Drugmaker consolidation, price hikes ahead of impending patent expirations and hyperinflation on older medications without therapy class competition all contributed to increased drug spending.

Express Scripts’ exclusive Prescription Price Index shows rapid inflation in the price of medications, with the average price of brand name drugs increasing 16.2% in 2015 and 98.2% since 2011. One-third of branded products experienced 2015 price increases greater than 20%.

Prescription Price Index

Express Scripts’ size, scale and focus delivered cost savings for clients, helping to mitigate the effect of this inflation through a 2.7 percentage point decrease in trend through drugmaker rebates.

In addition, our National Preferred Formulary is leveraging competition among similar drugs in the same therapy class, keeping down costs while maintaining quality. Clients who implement our NPF in 2016 will save $1.3 billion; clients enrolled since 2014 will achieve $3 billion in cumulative savings.

Express Scripts’ Inflation Protection Program – a component of the Express Scripts SafeGuardRxSM program – offers budget predictability by holding inflation to levels significantly below the industry average.

Improving Patient Care, Decreasing Spend

Hepatitis C treatment was a leading reason why drug spending increased in 2014 at the highest rate in more than a decade. However, payers enrolled in Express Scripts’ Hepatitis Cure Value Program® effectively addressed the challenge of providing curative therapy to all hepatitis C patients, not just those with the most severely damaged livers. In 2015, these payers lowered the cost of curative therapy by 50%, saving $1 billion while providing treatment to nearly 50,000 patients.

In addition, our Accredo specialty pharmacy delivered industry leading persistency rates for Viekira Pak® (ombitasvir/paritaprevir/ritonavir; dasabuvir) and Harvoni® (ledipasvir/sofosbuvir) of 93 to 94%, compared to 83 to 92% at other retail and specialty pharmacies.

Payers also effectively mitigated the dramatic increases in spending on compounded medications that occurred in 2014, achieving a 97% drop in total plan costs for this class in 2015 through Express Scripts’ compound management solution.

Specialty Drivers of 2015 Spend

Despite being used by only 1-2% of the population, specialty medications accounted for 37% of U.S. drug spend in 2015 and are projected to reach 50% by 2018. Spending on specialty medications increased 17.8% in 2015.

  • For the first year, a specialty disease class – inflammatory conditions, which includes rheumatoid arthritis – is the costliest overall drug category. Unit cost increases greater than 17% for Enbrel® (etanercept) and Humira® Pen (adalimumab), contributed significantly to the 25% spending increase for the inflammatory conditions medication class.
  • Inflammatory conditions, MS and oncology represent more than half (56.3%) of the nation’s spend on specialty medications.
  • The price of Gleevec increased 19% last year, just ahead of its patent expiration last month, contributing significantly to the 23.7% annual spending increase for oncology.

Specialty Drivers

Traditional Drivers of 2015 Spend

Among non-specialty therapy classes, diabetes was the most expensive, with an overall increase in spending of 14%, driven equally by increases in utilization and unit cost. Lantus® (insulin glargine), the preferred insulin on our NPF, had a 13.7% decrease in unit cost. However, high costs for pre-filled insulin pens and newer expensive therapies continue to drive spend in the category.

Traditional Drivers

What’s Ahead

Total drug spending is forecast to increase between six and eight percent annually between 2016 and 2018. Specialty spending, led by inflammatory conditions and new discoveries for cancer, is forecast to increase an average of 17% annually over the next three years.

Trend Forecast

Managing specialty will continue to be a top priority for payers. Our Oncology Care Value ProgramSM launched earlier this year is applying indication-based reimbursement to align the cost of care with treatment outcomes.

Expanding indication-based reimbursement to categories like inflammatory conditions can help payers manage that spend in future years.

We also need to tap into the potential $39.7 billion in savings from biosimilars over the next five years. Non-brand alternatives for two of the top three inflammatory drugs – Remicade® (infliximab) and Humira – may reach the U.S. market in 2017.

Specialized care and bold actions matter. Express Scripts practices pharmacy smarter, fighting for our clients and standing with patients to put medicine within reach.


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