As more biosimilars and specialty generics hit the market next year, this could lead to a shift in drug spending.
Pharmaceutical Strategies Group (PSG) has released its Artemetrix State of Specialty Spend and Trend Report, which uses integrated pharmacy and medical claims data to formulate views on specialty spending and trends.
Inflammatory disease remains the top category, with adalimumab (Humira; AbbVie) the number one drug for the plan’s overall cost, according to the report.
“The specialty trend returned to pre-pandemic levels in 2021 and bounced back to 14.2%,” PSG president Michael Lonergan, RPh, said in a statement.
“However, it is encouraging to see competition from biosimilars impacting costs, he said. “We saw an overall increase in use, from 12.4% in 2020 to 22.5% in 2021 and expect a more meaningful impact as biosimilars for [Humira] coming on the market next year.”
The use of claims continued to drive trends, similar to what was seen in 2020. About 9.4% of the 2021 14.2% was due to an increase in claims usage, while 4.4% was due to changes in cost per claim.
While expensive therapies are at the forefront, their use is driving specialized trends, researchers say.
Researchers believe that as expensive new therapies for higher-prevalence diseases come to market, such as those for asthma and migraines, the trend is likely to continue.
However, the researchers estimate that if biosimilars and specialty generics hit the market next year, it could lead to a shift.
In addition, researchers found that the percentage of medical specialty spending compared to pharmacy benefit is 35.5% to 64.5%, respectively, reflecting 2016 percentages.
“While the definition of what includes specialty drugs has shifted since the beginning of this report 6 years ago, the importance of proactive management of specialty drug programs has not changed. “Our data provides the precision needed to track trend drivers and keep pace with rapidly changing market complexity, enabling the construction of appropriate plan strategies,” said Renee Rayburg, RPh, vice president of Specialty Clinical Consulting, in the statement.
“Access to integrated data creates the opportunity to align PPE and health planning strategies to achieve the maximum financial benefit,” she said.
The cost of specialty drugs continues to rise, reaching an average of $1,295 per member per year, which is roughly double the cost in 2016.
Probably related to the pandemic, the trend declined to 11.8% between 2019 and 2020, but recovered to 14.2% between 2020 and 2021.
The percentage of the population using at least 1 specialty drug increased to 5.9% in 2021, after stabilizing at 4.8% between 2019 and 2020.
“The Artemetrx Specialty Spend and Trend report is an important resource to assist with the assessment and design of specialty pharmacy strategy,” said Timothy Carroll, PharmD, vice president of Business Development and Analytics at Reliance Rx, in a statement. a statement. “It becomes more important as new therapies, generics and biosimilars are introduced and paradigms are constantly shifting.”
The report continues to inform payers and sponsors about opportunities and decisions in the future.
Proprietary State of Specialty Spend and Trend Report issued by Pharmaceutical Strategies Group. news item. Pharmaceutical Strategies Group. Aug 23, 2022. Accessed Aug 23, 2022. Email.