Record-Low Increase in Rx Spending in 2017

Feb 6, 2018

In 2017, as the nation debated ways to rein in drug prices, Express Scripts did just that: We achieved record-low drug trend – the year-over-year change in drug spending – across our commercial, Medicare, Medicaid and health insurance exchange lines of business.

DTR 2017

Express Scripts' 21st annual Drug Trend Report illustrates how we improve cost and care for clients and members. In 2017:

  • Commercial plans saw the lowest increase in drug spending in 24 years – just 1.5%, compared with 3.8% in 2016. Almost half of our commercial plans spent less per person in 2017 than they did in 2016.
  • For Medicare plans, trend decreased by 2.4%, compared with a 4.1% increase in 2016.
  • For Medicaid plans, trend increased by just 3.1%, down from a 5.5% increase in 2016.
  • For health insurance exchange plans, trend decreased by 4.1%, far less than the 14% increase seen in 2016.
  • Our plans saved $32 billion by adopting clinical solutions in 2017.

The rising price of prescriptions hits consumers as well as plan sponsors. By keeping patients at the center of all we do, Express Scripts helped keep their average out-of-pocket costs steady. Commercial members paid 14.3% of total prescription costs in 2017, the same as in 2016. Across our lines of business, members saw a modest 12-cent increase in out-of-pocket costs per prescription since 2016.

We’re proud of what we accomplished for patients and plans in 2017, but our work is far from done. While the average plan members’ share of prescription drug costs rose very modestly, we know many still struggled to afford their medication. We will continue to help plans create even more headroom so they can keep member cost-share low and coverage broad, and to do more for those patients for who are challenged by their out-of-pocket costs.

Key Focus Areas for 2018

Gaps in coverage: We’ll build upon Inside Rx, which we launched in 2017 to help Americans who couldn’t afford medication due to inadequate coverage, and SmartShare RxSM, a program that allows clients to share the value of brand rebates with members at the time of purchase.

Opioid abuse: We made extraordinary progress last year through the launch of our Advanced Opioid ManagementSM solution. This year, we’ll do even more.

Specialty medications: These medicines account for 40.8% of total spending under the pharmacy benefit, and that figure will continue to increase.

Gene therapy: Affording these new treatments, which have the potential to cure previously untreatable and difficult-to-treat conditions, will require reimbursement models as innovative as these therapies.

Public policy: Our companion report on public policy highlights these new areas that require regulatory attention to make medication safer and more affordable:

  • Improve the speed of adoption of biosimilars
  • Encourage value-based reimbursement across all types of benefits
  • Leverage e-prescribing technology to improve the safety of opioids and other controlled substances
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