Our recent analysis, Super Spending: U.S. Trends in High-Cost Medication Use, examines prescription drug use among patients with exceedingly high annual medication costs under the pharmacy benefit to help clients identify new opportunities to improve care, quality of life and health outcomes for the patients who rely on these costly, complex therapies.
An estimated 576,000 Americans spent more than the median household income on prescription medications in 2014. This population of patients grew an astounding 63% from 2013. Further, the population of patients with costs of $100,000 or more nearly tripled during the same time period, to nearly 140,000 people. The total cost impact to payers from both patient populations is an unsustainable $52 billion a year.
Profile of a High-Cost Population
The patients in these extremely high-cost patient populations are overwhelmingly taking specialty medications, and have multiple comorbidities, prescriptions and prescribers. In fact, nine out of 10 patients with drug costs of $50,000 used specialty medications.
Among patients whose costs reached $100,000 or higher:
- More than one-third of these patients were being treated for ten or more different medical conditions. The most common co-morbidities included high blood pressure, high cholsterol, diabetes and depression.
- Of note, the use of antidepressants was more than twice as prevalent as it is in the general population.
- Approximately 60% took 10 or more different medications.
- Approximately 72% had prescriptions written from at least four prescribers.
- 58% of the population were Baby Boomers, aged 51-70.
- Men represent 56% of patients with annual prescription costs exceeding $100,000.
Top Therapy Classes
Compounded therapies, hepatitis C and cancer medications, comprise nearly two-thirds of drug spending in patients whose costs exceed $100,000 in 2014. Among patients in this highest-cost tier, 32% were taking cancer medications, and the number of patients receiving medication treatment for hepatitis C jumped 733% in 2014.
Compounded medication use was the third-largest contributor to these extremely high medications costs. Among Americans with annual drug costs above $100,000, the proportion of patients using compounded medications grew 30% in 2014, while their costs on these compounded medications quadrupled.
Patients Pay a Small Fraction of the Total Expense
Insurance plans and employers covered more than 98% of the costs for patients whose prescription drug bills exceeded $100,000 in 2014, paying an average of $156,911 of these patients’ 2014 pharmacy costs. Patients within this highest-cost tier were responsible for less than 2% of their total 2014 pharmacy costs, paying an average $2,782 out-of-pocket in 2014. This reflects an annual decrease in the out-of-pocket percentage these patients paid in 2013.
Average Annual Cost Per Patient
The size, complexity and make-up of the patients in this population are a significant challenge for payers and require swift and effective solutions to improve care for these costliest patients.
Reducing waste can create headroom for affordable coverage for patients who desperately need treatment. For example, addressing wasteful spending on compounded therapies that add little value to patient outcomes, and in a growing number of cases, may actually put a patient’s health at risk, can eliminate a significant contributor to high-cost medication use while protecting patients.
Programs that improve medication adherence, particularly for patients with cancer and diabetes, can improve outcomes and help additional medical spending that result from less than optimal management of these conditions.
Lastly, use of Express Scripts home delivery pharmacy and Accredo specialty allows us to treat the whole patient by providing a home pharmacy that offers integrated, coordinated care with specialist pharmacists, physicians, nurses, nutritionists and other specialists. We deliver more efficient, effective and personalized patient care for these vulnerable patients. And we guarantee it.
The rapid growth of these patient populations threatens the affordability of medical coverage for patients and plan sponsors. A comprehensive management approach that effectively improves patient care and outcomes while reducing costs – and especially cost associated with wasteful spending – will help ensure new, innovative medications are readily available and affordable to the patients who need them most.
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