Over the next three years, more than 80 percent of drug costs will be concentrated in seven therapeutic categories, according to Medco Health Solutions.

However, drugs for the central nervous system and endocrine/diabetes drugs will account for almost 40 percent of spending growth.

“Pharmacy directors at health insurance plans can develop more effective plan strategies by utilizing management tools that can help to improve adherence while controlling overall health care costs, especially in the high trending areas of specialty drugs and chronic disease,” says Glen Stettin, MD, Medco’s chief medical officer.

Cardiovascular treatment consumes a large share of total drug spending, about 22 percent, but marketing developments are expected to slow increases, and cardiovascular drug spending is expected to account for only 11 percent of overall drug spending from now until 2013.

Existing generics as well as “patent expirations for Lipitor [which expired in November] in the cholesterol-lowering class and Plavix [expected to expire in May] in the antiplatelet class and several new generics in the angiotensin II receptor blocker (ARB) class will contribute to this shifting pattern,” the pharmacy benefit company notes in its Drug Trend Report.

Researchers also point out that “the high cost for new anticoagulant drugs and utilization increases for cholesterol-lowering drugs will be responsible for most of the [increase] in the cardiovascular category.”

The report cites predictions by the Centers for Medicare & Medicaid Services that the average annual increase in national drug expenditures will be about 6.3 percent through 2019.

Stettin says that “while there are factors that will continue to drive drug spending upward for a number of major disease categories, taking full advantage of generic versions of blockbuster medications that are entering the market over the next few months will help mitigate some of those rising costs.”

Drug cost increases, 2011–2013. Each category’s percentage of total projected increase in plan ingredient cost

Source: Medco, Drug Trend Report 2011

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There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.