Cancer condition categories accounted for $378 million (48 percent) of the total increase in spending, with the largest increases for specified specialty drugs. (Photo: Shutterstock)
The use of very expensive specialty drugs is increasing—and so is the cost to employers, according to a research study by Prime Therapeutics LLC.
Prime's study analyzed the 2016-2018 pharmacy claims data of more 17 million commercially insured members, to identify the trends of "drug super spender" members, defined as those with greater than $250,000 in total drug cost per year. While still a small population—0.0275 percent of all members in 2018—the group's percentage of total drug spend is increasing—from 6.3 percent in 2016 to 8.6 percent in 2018, or roughly $2.1 billion in drug spend.
During those two years, the number of drug super spenders jumped 63 percent, to 4,869 members—and their costs also jumped, 60 percent, to $2.1 billion. In that same time frame, the number of drug super spenders with drug costs more than $750,000 increased 38 percent, and drug costs for members more than $750,000 increased to $417 million in 2018 from $297 million in 2016.
"With continued growth in treatments for rare diseases, including one-time treatments that may carry million-dollar price tags, it's very likely that health care cost will become even more skewed, with a smaller and smaller fraction of insured members accounting for a larger and larger portion of the total health care cost," says Prime's senior vice president, chief medical officer Jonathan Gavras.
"We must work to ensure drug and gene therapies are priced appropriately to the value they provide, obtained and billed via the cost-effective channel with the highest quality patient management, and value-based contracts are in place to recoup costs if the drug or gene therapy does not maintain effectiveness," Gavras says.
Of the $795 million increase from 2016 to 2018 in drug super spenders' total drug expense:
- Cancer condition categories accounted for $378 million (48 percent) of the total increase, with the largest increases for specified specialty drugs to treat breast, multiple myeloma, lung, kidney, colorectal, non-Hodgkin's lymphoma and melanoma cancers.
- Inherited single gene disorders accounted for $243 million (31 percent) of the total increase with the largest increases seen for hemophilia A and B, cystic fibrosis, spinal muscular atrophy, congenital hypophosphatasia, hereditary angioedema, cystinosis and Duchenne muscular dystrophy drug therapies.
- The other categories accounting for nearly all the remainder increase in drug super spender expense from 2016 to 2018 were: the treatment conditions for eculizumab (Soliris) including hemolytic-uremic syndrome, paroxysmal nocturnal hemoglobinuria, and myasthenia gravis; pulmonary hypertension; multiple sclerosis; and anti-inflammatory biologics.
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Katie Kuehner-Hebert
Katie Kuehner-Hebert is a freelance writer based in Running Springs, Calif. She has more than three decades of journalism experience, with particular expertise in employee benefits and other human resource topics.
