Rising costs, greater utilization drive increase in 2022 specialty drug spend

Specialty drug spend continued to increase last year, the latest Artemetrx State of Specialty Spend and Trend report found.

“Integrated specialty trend, net of rebates, rose to 12.5% in 2022,” said Libby Johnson, senior vice president and chief data analytics officer for Pharmaceutical Strategies Group. “An increase of 3.6% over 2021, rising specialty drugs costs and increasing utilization are impacting payers despite higher manufacturer rebates.”

The annual report, sponsored by Walmart, uses integrated pharmacy and medical claims data to provide a holistic view of specialty drug spend and trend. First published in 2017, sponsors say this report is the only comprehensive analysis of specialty drug spending.

Specialty drug trend continued to be driven primarily by claim utilization, accounting for nearly three-quarters of the overall 14.1% gross trend. However, cost per claim played a larger role in specialty trend than has been observed recently. High-cost therapies entering the market, expanded indications for existing expensive specialty medications (especially in the inflammatory category), increases in drug costs (some in the double digits) and shifts in channel likely all contributed to the increase in trend attributable to cost per claim.

The number of members taking specialty drugs continued to rise (4% of members took at least one specialty drug), while the average number of claims per person remained steady.

The top categories for specialty drug spend remained unchanged in recent years, with inflammatory, oncology and multiple sclerosis leading the way. For certain market baskets, overall prices declined as innovator brands and biosimilars competed for market share.

The shift of spend from the medical benefit to the pharmacy benefit (which now represents 56.3% of specialty spend) observed in previous years continued, allowing for the maximization of rebates and a focus on utilization management. Rebates had a notable impact on average cost per claim, particularly in the pharmacy benefit channel.

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“Walmart plans to use the details in the Artemetrx report to inform our approach in delivering on programs and solutions that are driving value for our customers in both cost and services,” said Aleata Postell, senior director of Walmart Specialty Pharmacy.