2018 Drug Trend Report

In 2018, Express Scripts expanded access to innovative medications through solutions that improve quality and affordability.

Focusing on What Matters Most for Those We Serve

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Previous Reports

Express Scripts clinical innovations saved clients $45 billion in 2018, delivered a 25-year record low drug trend of just 0.4 percent across employer-sponsored plans, and an unprecedented -0.3 percent trend for Medicare plans, according to the findings of our 2018 Drug Trend Report.

Express Scripts’ solutions for driving lower drug prices and fostering the use of lower-net-cost treatments are making medication more accessible for beneficiaries. Unit drug costs decreased in 2018 for employer-sponsored and Medicare plans, while utilization of medications rose.

Patients in employer-sponsored plans paid just 6 cents more, on average, for a 30-day prescription than in 2017. Out-of-pocket costs, inclusive of deductibles and copayments, for members of employer-sponsored plans were 15 percent of total prescription costs in 2018.

Spending on traditional, non-specialty medications decreased 5.8 percent, while spending on specialty medications increased 9.4 percent. Specialty medications now account for 44.7 percent of total drug spending, up 3.9 percent from 2017.

Express Scripts SafeGuardRx® Leads the Way in Value-Based Care

Plans enrolled in SafeGuardRx programs, which closely manage high-cost drug classes, experienced better trends in the targeted therapy classes than plans not enrolled. For example:

  • Plans enrolled in the Diabetes Care ValueSM program had a 4.3 percent decrease in spending for diabetes medications, compared with a 7.5 percent increase in spending for plans not enrolled.
  • Since 2014, the Hepatitis Cure Value® program has improved the affordability and accessibility of hepatitis C therapies and delivered a 96 percent cure rate. As a result, spending on hepatitis C therapies declined nearly 48 percent in 2018, which kept the therapy class out of the top 15 costliest therapy classes for the first time since 2013.

Price Inflation

Despite list price inflation of 7.3 percent for the most commonly used traditional brand medications in 2018, drug costs for traditional drugs declined 6.5 percent for Express Scripts’ employer-sponsored plans, 5.5 percent for Medicare plans and 5.6 percent for exchange plans.

New in the 2018 report, the Express Scripts Specialty Prescription Price Index added tracking of list price inflation and deflation for the most commonly used specialty medications. While list prices for brand-name specialty drugs increased 7.1 percent in 2018, specialty drug costs increased only 2.1 percent for our employer-sponsored plans, 2.4 percent for Medicare plans, and 2 percent for exchange plans.

Looking Ahead

We are creating a sustainable future for plan sponsors while improving access for patients. By ensuring people get the right medicine at the right time at the right cost, Express Scripts helped tens of millions of people get the most value for each dollar spent on prescription drugs.

Due to these efforts, we forecast the annual increase in drug spending will be about 2 percent each year from now through 2021.

However, there is more work to be done, particularly for members who are still exposed to high out-of-pocket costs. From expanding the discounts available in our InsideRx® prescription savings program, to new digital resources for members, and advocating for smarter public policies, we are leading the way to make care better and more affordable for everyone we serve.

About the Express Scripts 2018 Drug Trend Report

Our annual Drug Trend Report is among the industry’s most comprehensive analysis of annual changes in the cost and use of prescription medications in the U.S. The research examined the de-identified prescription drug use data of approximately 34.2 million people with a pharmacy benefit plan administered by Express Scripts, including those in an employer-sponsored, Medicare, Medicaid or health insurance exchange plan.

In a companion report that reviews drug spending trends and public policy, Express Scripts once again calls upon stakeholders to act on a prescription drug affordability agenda.