Patients with highest drug costs are mostly using costly specialty drugs

A new analysis of trends in utilization of high-cost medication indicates that among patients spending the most on prescription drugs, most are using specialty drugs. Express Scripts’s new findings follow its March 2015 report of a 13.1% jump in prescription drug spending from 2013 to 2014, which it concluded was driven in part by expensive specialty drugs.

According to Express Scripts’s analysis, over half a million Americans had prescription drug costs of at least $50,000 in 2014, and of those, nine out of 10 used specialty drugs. Highlights of the report’s findings include a 63 percent increase from 2013 to 2014 in the number of patients with over $50,000 in drug spending, and a 193 percent increase in the number of patients with the highest drug spending (at least $100,000). The analysis indicates that these highest spenders accounted for 6.5 percent of all drug spending in 2014 (up from 2.5 of all spending in 2013).

Looking more closely at utilization among these highest spenders, the report notes that comorbidities and the use of four or more medications was common among those with at least $100,000 in drug spending – more than a third were treated for at least 10 conditions, and over 60 percent had at least 10 different medications. 32 percent of these highest spenders used a cancer drug. Meanwhile, with the advent of new and very costly hepatitis C drugs, the number of highest spenders filling prescriptions for hepatitis C drugs jumped 733 percent in 2014.

The analysis further suggests that plan sponsors are taking on the brunt of costs for expensive medications, paying an average of 98 percent of the total expense for patients with $100,000 or more in 2014 drug spending.

For more on unfolding trends in prescription drug spending, see our previous blog posts:

Pharmaceutical spending up slightly in 2013

More expensive specialty drugs boost overall prescription drug spending

Decline in pharmaceutical spending growth a major factor in the health spending slowdown