According to the Express Scripts Prescription Price Index, prices on a market basket of the most highly utilized brand-name medications increased 13.3 percent from September 2011 to September 2012, far outpacing the overall economic inflation level of 2.0 percent. During the same timeframe, prices of generic medications declined 21.9 percent. This 35.2 percentage point net inflationary effect is the largest widening of brand and generic prices since Express Scripts began calculating its Prescription Price Index in 2008.
“The patent cliff has fueled a growing price disparity between brand-name and generic medications,” said Steve Miller, M.D., chief medical officer at Express Scripts. “The trend emphasizes the nation’s continued need for the tools we employ to help patients make better decisions, including generic use when appropriate.”
Drivers of Traditional Drug Trend
During the first three quarters of 2012, spending on traditional medications decreased 0.6 percent over the same period in 2011, primarily driven by lower prices brought on by increased use of generic medications.
The top traditional therapy class is mental and neurological disorders (including antidepressants), which now consumes 24.7 percent of all traditional drug spend. Although use of these medications has increased 3.1 percent compared to the first three quarters of 2011, total spending in this class is down 1.9 percent due to newly available generic antidepressants and antipsychotics.
Total spending on medications to treat high blood pressure and high cholesterol decreased 7.7 percent, primarily driven by the continued impact of patent expirations for blockbuster drugs.
Drivers of Specialty Drug Trend
Specialty drug trend continues its year-over-year double-digit growth. During the first three quarters of 2012, spending on specialty medications increased 22.6 percent over the same period in 2011, primarily driven by unit cost increases. In the first nine months of 2012, specialty drug costs consumed 20.8 percent of total pharmacy spend.
“The continued rise in spend on specialty medications underscores the nation’s need to accelerate the pathway for biosimilars,” Dr. Miller said. “Additional competition within these therapy classes would provide a necessary market control against price inflation.”
The three therapy classes representing the largest amount of specialty drug spend continue to be rheumatoid arthritis/autoimmune conditions, multiple sclerosis and cancer.
Medications commonly used to treat hepatitis C continue to have the largest specialty spend increase, 117.3 percent over the same period in 2011. Increased utilization is driving this trend, as new patients begin and continue treatment with one of two new medications.
Eight of the nine notable new medications approved in the third quarter are specialty medications. Many of these medications are second-line and third-line drugs indicated to treat advanced cancers.
Spotlight on Obesity Medications
The report reviews the two new anti-obesity medications approved this summer by the U.S. Food and Drug Administration. In clinical trials, many patients taking either of the new medications lost at least 5 percent of their body weight.
“The potential benefits of these new anti-obesity medications need to be compared against their risks and cost,” Dr. Miller said. “We are cautiously optimistic about the possibilities of these and other drugs like them, provided that they are prescribed appropriately and integrated with other lifestyle modifying programs that help patients make healthier choices that maintain their weight over time.”