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The upward trend in specialty drug spending continues, largely driven by market forces. Specialty drug spend grew 19.5 percent in 2009, due mainly to the increased cost per unit, according to Express Script’s 2009 Drug Trend Report. On average, less than 1 percent of plan sponsors’ members used specialty drugs (although prevalence of use increased), but the average cost of $1,867 per prescription accounted for more than 12 percent of total pharmacy spend.
Lack of generics and limited competition are credited with the higher drug-price inflation — 11.5 percent — among specialty drugs, compared with only 9.1 percent for branded nonspecialty medications. Inflammatory conditions, multiple sclerosis, and cancer again were the top three therapy classes, representing 67 percent of total specialty drug spend. Overall, specialty-drug spend is expected to continue to grow at a rate of 20 percent to 23.5 percent annually over the next three years, with cost and utilization increases contributing about equally to that growth.
Because approximately 55 percent of total spending for specialty drugs occurs on the medical benefit side, total specialty spending may be approaching $250 per member per year (PMPY) for some plan sponsors. In addition to the top three therapy classes, the biggest PMPY drivers over the next three years are projected to be respiratory conditions (+250.8%), Hepatitis C (+155.2%), pulmonary hypertension (+60.7%), RSV prevention (+75.3%), and infertility (+39.5%) .