What are the recent and forecasted trends in prescription drug spending?

The cost of prescription drugs has become a hot-button issue with consumers and policymakers.  One in four people taking prescription drugs report difficulty affording their medication and recent Kaiser Family Foundation opinion polling has found bipartisan support for government action to lower prescription drug costs. This chart collection explores trends in spending on prescription drugs, and an earlier brief also explored trends in this topic.  

Growth in prescription spending has slowed again in 2017, after increasing rapidly in 2014 and 2015

In 2017, per capita prescription drug spending slightly decreased (down 0.3%) for the first time since 2012. In 2015, pharmaceutical spending grew 8.1% on a per capita basis and in 2014 these costs had grown 11.5%, particularly because new specialty drugs came to market. Looking ahead, CMS projections suggests growth in per capita drug spending will be moderate through 2027.

Estimates suggest Rx drugs will represent a similar portion of overall health spending over time

Prescription drugs had represented a shrinking share of total health spending through 2013, but increased in 2014 and 2015 with the introduction of some high cost specialty drugs. In 2017, drug spending did not grow as much as spending on other services, however, CMS projects drug spending as a portion of overall health spending will remain consistent over time.

Spending on prescription drugs has risen rapidly over past decades

On a per capita basis, inflation-adjusted retail prescription drug spending in the U.S. increased from $90 in 1960 to $1,025 in 2017.

Out-of-pocket spending for Rx drugs remained flat in 2017, while out-of-pocket spending on hospital and physician services grew

In 2017, per capita out-of-pocket spending on prescription drugs was down slightly from the previous year ($144 per person in 2017 and $145 in 2016). However out-of-pocket spending on physician services increased (from $182 per person in 2016 to $185 in 2017), as did hospital out-of-pocket spending (from $99 per person in 2016 to $104 in 2017).

Most people taking Rx drugs say they can afford their treatment, but about 1 in 4 have a difficult time affording their medicine

About one in four people taking prescription drugs report difficulty affording their medication, and a 2018 Kaiser Family Foundation Poll found that 52% of respondents said that passing legislation to bring down the price of prescription drugs should be the government’s top priority. 

Out-of-pocket costs for Rx drugs are expected to increase, but will likely represent a smaller portion of overall Rx spending

While per capita out-of-pocket spending on prescription drugs is expected to grow in coming years, it has fallen as a share of total drug spending and this trend is projected to continue into future years. Medicare is expected to represent a growing share of drug spending over the next decade.

Recent drug spending growth has largely been due to new brands, high prices for existing drugs, and fewer patent expiries

According to an analysis by IQVIA (formerly the IMS Institute for Healthcare Informatics) net spending on drugs in 2017 was driven largely by the introduction of new brands and price increases for existing drugs still under patent protection. Compared to the previous years, the price of generics had a downward effect on overall drug spending. The report finds that the effect of patent expiries has been largely unchanged over the past four years.

Costly new specialty drugs were a major driver of a recent spike in health spending

Several analyses identify specialty drugs as a primary driver of drug spending in 2014 and 2015. Specialty drugs are used for the treatment of complex, chronic, or rare conditions such as cancers and hepatitis C. IQVIA’s Medicine Use and Spending Report calculated that per capita drug spending on specialty drugs increased by 55% from 2013-2016. Since it has tapered off in the past two years, overall per capita drug spending has began to decrease (down 2.2% in 2017).

For enrollees on private insurance, medicines for inflammatory conditions topped drug spending in 2017

The Express Scripts 2017 Drug Trend Report found that in 2017, medicines for inflammatory conditions were the most expensive therapy class drugs, ranked based on per-member-per-year (PMPY) spending. PMPY spending on inflammatory medications was $159.49 in 2017, followed by $116.23 for diabetes medication, and $70.66 for oncology drugs. PMPY spending on most of the top five therapy classes, diabetes excluded, is driven primarily by spending on specialty drugs (including Multiple Sclerosis and HIV drugs, which can only be treated with specialty drugs).

Growth in price and utilization of pharmaceuticals has varied over the past 25 years

For much of the past two decades – with the exception of the period surrounding the economic downturn – growth in utilization outpaced growth in pharmaceutical prices. Due to the way drugs are selected for inclusion in the price index, it can take some time for new drugs to be incorporated into the index. The price index for drugs has held relatively stable since the mid-1990s (ranging in growth from about 1% to 5% annually), while the utilization index has changed more over time. 

Generic drug prices have declined while branded drug prices have nearly doubled in price

While generic drug prices have decreased over time, there have been some increases during the 2008-2016 time period. According to data from Express Scripts, instances of generic drug price inflation have been due to manufacturer consolidation (fewer manufacturers producing the generic) and/or temporary shortages of active ingredients needed to produce the generic drug.

The average price of Humira in the United States is about 96% higher than in the United Kingdom

Humira, prescribed to treat rheumatoid arthritis, is priced 96% in United States than in the United Kingdom, according to data from the International Federation of Health Plans. The average price of Humira in the U.S. is 225% higher than in Switzerland.

The average price of Xarelto in the U.S. is more than double the price in the United Kingdom

Xarelto, a drug prescribed to prevent or treat blood clots, is priced more than twice as high in the United States, on average, than in the United Kingdom or Switzerland.

The average price of Harvoni in the U.S. is 42% higher than in the United Kingdom

Harvoni, a high-cost specialty drug prescribed to treat Hepatitis C, is priced 42% higher in the United States, on average, than in the United Kingdom and 90% higher than in Switzerland.

The average price of Truvada in the United States is 44% higher than in Switzerland

Truvada, prescribed to treat HIV/AIDS, is priced 44% higher in the United States, on average, than in Switzerland, and 89% higher than in the United Kingdom.

The average price of Tecfidera in the United States is 174% higher than in Switzerland

On average in the United States, Tecfidera (prescribed to treat relapsing multiple sclerosis) is priced 174% higher than in Switzerland, and 668% higher than in the United Kingdom.

The average price of Avastin in the United States is 124% higher than in Switzerland

Avastin, prescribed to treat some cancers, is priced 124% higher in Switzerland, on average, and 125% higher than in the United Kingdom. Unlike some other drugs included in the International Federation of Health Plans, the price range for Avastin is relatively large; the 25th percentile was $2,289 and the 95th percentile was $8,831 in 2014.

Drugs count for a bigger share of health spending than many think

In 2017, prescription drugs accounted for 10% of U.S. health spending but 21% of employer insurance benefits. That is not much less than the 23% employers spent on inpatient hospital care.

Medicare has become a major payer for prescription drugs

With the launch of Medicare Part D in 2006 and more recently the ACA’s closing of the “Donut Hole” (a prescription drug coverage gap resulting in Medicare enrollees paying out-of-pocket in addition to their deductible and copayments or coinsurance), Medicare has become a major payer for prescription drugs. From 2005 to 2017, Medicare’s contribution to total national health spending on prescription drugs jumped from just 2% to 30%, making it the second largest contributor to drug spending after private insurance.

Most Americans favor action to keep drug prices down

When asked about policy options for keeping prescription drugs cost down, 86% of Americans favored requiring drug companies to report on how drug prices are set. Ninety-two percent favored allowing Medicare to negotiate with drug companies for lower drug prices, up from 82% the previous year. 78% favored limiting prices for high-cost drugs (e.g., for cancers and Hepatitis C), and 72% favored allowing the purchase of drugs imported from Canada.