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ESI report notes fall in spending on traditional drugs

Decrease attributed to greater generic use

ST. LOUIS — While the country's spending on specialty drugs increased by 18.4% in 2012, spending on traditional drugs fell for the first time in 20 years, according to a report by Express Scripts.

The pharmacy benefit manager's 2012 Drug Trend Report found that spending on drugs used to treat such common diseases as high cholesterol and blood pressure, most of them pills, decreased by 1.5%, mainly due to increased use of generics. Total drug trend for the year was 2.7%, consistent with the rate of growth in 2011. Prices for the most highly utilized branded drugs increased by 12.5% in 2012, outpacing the Consumer Price Index's 1.7% inflation rate, while prices for generic drugs decreased by 24%.

"The first-ever decrease in traditional drug spending is the latest chapter of an ongoing success story for our utilization management programs and for the increased interest in generic medications, home delivery pharmacy and more focused retail pharmacy networks," Express Scripts SVP clinical research and new solutions Glen Stettin said.

The report noted that the patent cliff last year resulted in the introduction of low-cost generic alternatives for many blockbuster drugs and increased utilization in eight of the top 10 traditional therapy classes, while unit costs decreased in seven. But for the second consecutive year, the country spent more on prescription drugs for diabetes than for any other therapy class, with diabetes drug spending increasing by 11%, driven in part by unit cost increases for popular insulins. Drugs for attention disorders also saw an increase in spending, by 14.2%, with an 8.8% increase in utilization, thanks to an increase in adult patients.

Within the pharmacy benefit, specialty drugs accounted for 24.5% of the country's total drug spending, the highest percentage on record. Four of the 15 most expensive-to-treat diseases in the country in terms of drug spending are treated with specialty medications, including inflammatory conditions, multiple sclerosis, cancer and HIV. The most expensive specialty category overall, rheumatoid arthritis, saw spending increase by an additional 23%, driven by both a 9% increase in utilization and a 14% increase in unit cost. The largest increase in drug spending was for hepatitis C, which saw a 33.7% increase, due almost entirely to the introduction of new drugs in 2011; spending on hepatitis C medications is expected to increase 32.3% this year and 56.3% next year. Costs for cancer drugs increased by 22.3%, while utilization increased by 3.4%. Overall, in 2012, the Food and Drug Administration approved 22 new specialty drugs, many of which host more than $10,000 per month of treatment.

Other findings include an indication that younger physicians and those practicing in Midwestern states are more likely to prescribe generics to Medicare patients, while the largest percentage increase in Medicaid drug spending, 24.3%, was for chemical dependence due to the rise in the number of Americans seeking treatment for drug and alcohol abuse. Utlization of cancer drugs increased by 11.8% for Medicare patients, while Medicare patients increased utilization of medications for hepatitis C by 63.5%; hepatitis C infection rates are more prevalent among patients born between 1945 and 1965. Medicaid also spends more on asthma medication than prescription drugs for any other single condition, and total asthma drug spending increased by 6.2%.

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