According to the 2016 Express Scripts Drug Trend Report, spending on medications to treat both high blood cholesterol and high blood pressure medications decreased in 2016, yet these two categories still contribute significantly to pharmacy spending for payers.
Here’s a look at 10 spending trends for medications that treat high blood cholesterol and high blood pressure/heart disease:
1. GENERICS MATTER: Across all payers, generics widely influenced a decrease in overall spending for cholesterol and high blood pressure/heart disease medications in 2016. Generics accounted for more than 90% of the market share for both cholesterol and high blood pressure/heart disease categories.
2. 1 IN 10 TREAT HIGH CHOLESTEROL: Nearly 11% of commercially insured Americans used at least one medication to treat high cholesterol in 2016. Commercial plans spent $38.45 per member on these medications, making it the 7th costliest therapy class. Overall spending decreased 7.4% in 2016.
3. NEARLY 20% TREAT HBP/HEART DISEASE: Close to 17% of commercially insured Americans used at least one medication to treat high blood pressure/heart disease in 2016. Plans spent $34.52 per member on these medications, making it the 9th costliest class of therapy. Overall spending decreased 9.1% in 2016.
4. THE COST OF HIGH CHOLESTEROL: The average cost for a high cholesterol medication for commercial payers was $35.70 in 2016; for high blood pressure/heart disease, the average cost of a medication was $13.89.
5. PCSK9 TREND: Spending on specialty cholesterol medications, which include PCSK9 inhibitors, saw a decline in unit cost and an increase in utilization in 2016. Overall spending (cost + utilization) increased 15% in the class in 2016. Specialty cholesterol medications are analyzed separately from traditional medications for high cholesterol.
6. GOOD NEWS – CVD SPENDING EXPECTED TO DECLINE: Total spending on medications for high cholesterol and high blood pressure/heart disease is expected to decline over the next three years.
7. NONADHERENCE IS COSTLY: More than a quarter of patients who used cardiovascular medications in 2016 were not adherent with their therapy (26.4% for cholesterol, 27.8% for high blood pressure/heart disease).
8. TAKING THE PULSE OF EXCHANGE PLANS: Use of cholesterol and high blood pressure medications increased 6.5% and 6.2%, respectively, among patients enrolled in a Health Exchange Plan in 2016. The increased utilization, which was offset by decreased unit costs in each of the classes, demonstrates that the population is expanding beyond those with chronic and complex illnesses.
9. MONITORING MEDICARE: Medicare Part D plans spent more than $200 per member in 2016 on medications in each class of therapy, more than 5 times the amount spent by commercial payers. Overall spending decreased for both high cholesterol and high blood pressure/heart disease classes; however, due to utilization and unit cost decreases for high cholesterol; and unit cost decreases for high blood pressure medications.
10. MONITORING MEDICAID: For Medicaid managed care plans, spending on high blood pressure medications increased 2.4% in 2016, largely due to a 1.9% increase in utilization. These plans spend $16.07 per member on these medications in 2016, making it the 15th costliest class of therapy.
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