Despite the continued rapid uptake in specialty and biologic drugs, overall drug spending across commercial, Medicare, and Medicaid managed care plans increased just 2.7 percent last year over 2011.* The effect of specialty drug costs was mitigated by the first decrease in traditional drug spending in more than 20 years, according to Express Scripts.

The traditional-drug spending trend was driven by higher generic-drug utilization, thanks to the arrival of the patent cliff. As managed care plans provided members with incentives to switch from brand-name pharmaceuticals to generic alternatives, utilization for 8 of the top 10 traditional therapy classes actually increased. Unit-cost decreases in 7 of those classes, however, more than compensated for the demand.

Specialty drugs continue to be a different story. Specialty-drug spending increased more than 18 percent over 2011, the strongest increase since 2004. Hepatitis C, respiratory, and cancer drugs led the way, each with spending increases of more than 25 percent. Biologics for inflammatory conditions represented the highest per-member, per-year spend — $50.62.

Specialty vs. nonspecialty

Specialty vs. nonspecialty

*Based on Express Scripts’ book of business. Express Scripts is the largest PBM in the United States.
Sources: Medco Drug Trend Reports 2009, 2010, 2011. Express Scripts Drug Trend Reports, 2012, 2013.

— Michael D. Dalzell

Managed Care’s Top Ten Articles of 2016

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.

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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.

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