Managed Care

Specialty anti-inflammatories see huge increase in utilization

Americans spent 34 percent more for specialty anti-inflammatory agents used to treat rheumatoid arthritis in 2005 than any other specialty drug category. The specialty anti-inflammatory class had the highest per-member per-year (PMPY) expense of all specialty classes, according to the Specialty Drug Trend Report from Express Scripts. The class, comprising four agents — Enbrel, Humira, Kineret, and Remicade — accounts for 19 percent of total specialty spending within the pharmacy benefit. Enbrel alone accounted for more than 75 percent of this cost.

In 2005, the class cost per prescription increased 9.4 percent and the PMPY cost was $9.36 according to the Express Scripts data.

This increase can be attributed to utilization growth, according to the report. Increases in utilization are due largely to earlier and longer treatment for diseases such as rheumatoid arthritis. Multiple indications also increase utilization. Medications in this therapy class are also used to treat conditions such as psoriasis, psoriatic arthritis, ankylosing spondylitis, and Crohn's disease.

After anti-inflammatories, the class of drugs used to treat multiple sclerosis showed the next largest increase at 11.7 percent per prescription. Drugs in this class include Avonex, Copaxone, Rebif, Betaseron, and Tysabri.

Which specialty drug classes declined? Infertility drugs saw a 3.9 percent drop in utilization, as did antivirals, which were down 6.7 percent.

Enbrel dominates this therapy class

Projected expenditures for specialty medications, 2005 vs. 2009

Source: 2006 Express Scripts Specialty Drug Trend Report

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