“‘Spending and utilization for specialty pharmaceuticals’ was one of the AMCP Foundation’s Top 10 Emerging Health Care Trends, as published in our landmark report in 2014. Health plans, insurers, pharmacy benefit managers, and purchasers struggle to control specialty pharmacy costs and ensure the affordability of effective medications while addressing patient and consumer access issues. This ultimately affects two other key trends, increasing patient cost sharing and the migration to value-oriented health care marketplace. In this article, we update developments in several important areas.
Specialty Trend Rises, but with Rays of Hope
Overall, specialty drugs now account for 1/3 of all pharmaceutical spending. The annual increase in specialty pharmaceutical expenditures rose by 17.7% in 2015, according to Express Scripts, and slowed somewhat in 2016. The cost trends for specific specialty categories are predicted to remain high through 2020 (e.g., about 30% for inflammatory conditions and 21% for oncology). One positive sign is that expenditures for hepatitis C specialty drugs fell 34% in 2016 and may continue double-digit declines through 2020 (mainly because of lower utilization and perhaps also due to competition from other treatment options).”