Study finds specialty drug costs increase 15% annually

Prime Therapeutics, Blue Cross and Blue Shield of Minnesota study examines RA, hep C drug costs

SAN DIEGO — Specialty drugs are expected to account for 50% of all drug costs by 2018, according to two new studies.

By contrast, specialty drugs accounted for 20% of all drug costs in 2009, but increased to 28.7% by 2012. Pharmacy benefit manager Prime Therapeutics and Blue Cross and Blue Shield of Minnesota conducted the studies, and Prime is presenting them Tuesday at the Academy of Managed Care Pharmacy's 25th annual meeting and expo in San Diego.

"The increasing rate of specialty drugs expenses is due to increased non-specialty generic use; expected continued pharmaceutical, manufacturer, annual, double-digit price increases; increasing specialty drug use and future pipeline of new specialty drugs," Prime director of health outcomes Patrick Gleason said.

The studies, based on pharmacy and medical claims from 1.2 million commercially insured and continuously enrolled members receiving a drug for hepatitis C or rheumatoid arthritis, focused on cost-of-care trends for the two disease states.

In one, researchers found that despite use of specialty drugs for hepatitis C decreasing from 17.2% to 14.1% between 2008 and 2011, the compound annual growth rate during that time was 15%, and specialty drug costs accounted for $13,332 of the total $38,055 cost for hepatitis C care in 2008; by 2011, that figure had risen to $30,415 of $57,799.

The other study found that rheumatoid arthritis drug use rose from 34.6% to 35.4% between 2008 and 2010, with a compound annual growth rate in the cost of care of 7.3%. All other medical costs were $11,252 in 2008 and $13,710 in 2010, and combined medical and specialty drug costs for the disease accounted for $16,218 of $29,652, or 54.7%, in 2008. In 2010, the percentage was lower, at 53%, though costs accounted for $18,098 of $34,163.

"These studies show the RA and hep C pharmacy costs now go beyond all medical costs, therefore the expected medical savings cannot offset the specialty drug investment," Gleason said. "As pharmacy benefit managers and health plans strive to work to improve the quality of care for individuals with specialty drug needs, the expected increases in cost of care can be lessened through specialty pharmacy management programs."

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