Express Scripts Research Highlights $52 Billion Challenge for U.S. Healthcare System

- Nearly 600,000 Americans have annual medication costs above $50,000

- The number of U.S. patients taking at least $100,000 worth of prescription drugs tripled in 2014

- Majority of these patients take at least 10 medications, from at least 4 different prescribers

- Express Scripts solutions address critical opportunities to improve care and reduce costs for patients with high medication costs

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Express Scripts

May 13, 2015, 06:00 ET

ORLANDO, Fla., May 13, 2015 /PRNewswire/ -- As pharmaceutical companies introduce more high-cost medications for larger populations, employers, health plans and others are increasingly challenged to control the significant increase in spending that happens as a result, according to new research released this week by Express Scripts (NASDAQ: ESRX) during its annual Outcomes Symposium.

The new report, Super Spending: U.S. Trends in High-Cost Medication Use, examines prescription drug use among patients with exceedingly high annual medication costs under the pharmacy benefit. The number of U.S. patients estimated to have annual medication costs greater than $50,000 jumped 63 percent between 2013 and 2014, from 352,000 to 576,000 Americans. The population of patients estimated to be taking at least $100,000 worth of medication nearly tripled in the same time period, from 47,000 to 139,000 Americans.

"The profile emerging from this research shows these patients are overwhelmingly taking specialty medications, and have multiple comorbidities, prescriptions and prescribers," said Glen Stettin, M.D., Senior Vice President, Clinical, Research and New Solutions at Express Scripts. "These insights highlight clear opportunities for payers to work with their PBM to improve care, quality of life and health outcomes for the patients who rely on these costly, complex therapies."

Comorbidities, Polypharmacy Complicate Care
Nine out of 10 patients with drug costs of $50,000 used specialty medications, which are expensive treatments for complex conditions. However, the analysis reveals patients at the top of the pyramid of prescription spending are often afflicted with numerous comorbidities that add to the complexity and cost of their care. Among patients whose costs reached $100,000 or higher:

More than one-third were being treated for 10 or more different medical conditions;
Approximately 60 percent took 10 or more different medications; and
Approximately 72 percent had prescriptions written from at least four prescribers.

Depression was one of the most common comorbidities among patients with more than $50,000 in annual costs, with about one-in-three patients having at least one prescription for an antidepressant in addition to their other therapies. The prevalence of antidepressant use among patients taking a specialty medication was 2.3 times higher compared to the national average.

"Patients in these highest-spend categories are treating a complex condition along with other more common chronic conditions, such as diabetes or depression, which can leave them at risk for medication safety concerns and increased medical costs," said Dr. Stettin. "When we treat the whole patient, as we do in the Express Scripts Therapeutic Resource Centers^® and our specialty pharmacy, Accredo, we provide a home pharmacy that offers integrated, coordinated care with other members of the patients' healthcare team. The result is more efficient, effective and personalized patient care."

Costs driven by Hepatitis C, Cancer and Compounded Treatments
Compounded therapies, hepatitis C and cancer medications, comprise nearly two-thirds of drug spending in patients whose costs exceeded $100,000 in 2014. Among patients in this highest-cost tier, 32 percent were taking cancer medications, and the number of patients receiving medication treatment for hepatitis C jumped 733 percent in 2014.

Compounded medication use was the third-largest contributor to these extremely high medication costs. Among Americans with annual drug costs above $100,000, the proportion of patients using compounded medications grew 30 percent in 2014, while their costs on these compounded medications quadrupled.

"Unlike high-priced hepatitis C and oncology therapies, most compounded medications add little-to-no value to patient outcomes, and in a growing number of cases, may actually put a patient's health at risk," said Dr. Stettin. "Tightly managing the use of compounded medications offers a significant opportunity for payers to improve patient safety and reduce spending."

Majority of Patients in the Highest Spend Category are Baby Boomers
Baby Boomers, ages 51-70, surpassed all other age groups as the highest-cost medication users, making up 58 percent of the population with annual drug costs exceeding $100,000, an increase of 243 percent from 2013 to 2014.

Among Boomers in this high-cost category, 50 percent were being treated for cancer, 77 percent were being treated for hepatitis C, and 46 percent were taking compounded drugs.

Patients Pay a Small Fraction of the Total Expense
Insurance plans covered more than 98 percent of the costs for patients whose prescription drug bills exceeded $100,000 in 2014, paying an average of $156,911 of these patients' 2014 pharmacy costs. Patients within this highest-cost tier were responsible for less than 2 percent of their total 2014 pharmacy costs, reflecting an annual decrease in the out-of-pocket percentage these patients pay.

Methodology
The analysis examined de-identified prescription drug claims of 31.5 million insured Americans between 2013 and 2014. The research included beneficiaries with pharmacy coverage through commercial insurers, Medicare and Medicaid.

To review the full report, please visit lab.express-scripts.com.

About Express Scripts
Express Scripts manages more than a billion prescriptions each year for tens of millions of patients. On behalf of our clients — employers, health plans, unions and government health programs — we make the use of prescription drugs safer and more affordable. Express Scripts uniquely combines three capabilities — behavioral sciences, clinical specialization and actionable data — to create Health Decision Science^SM, our innovative approach to help individuals make the best drug choices, pharmacy choices and health choices. Better decisions mean healthier outcomes.

Headquartered in St. Louis, Express Scripts provides integrated pharmacy-benefit management services, including network-pharmacy claims processing, home delivery, specialty benefit management, benefit-design consultation, drug-utilization review, formulary management, and medical and drug data analysis services. The company also distributes a full range of biopharmaceutical products and provides extensive cost-management and patient-care services.

For more information, visit Lab.Express-Scripts.com or follow @ExpressScripts on Twitter.

Media Contacts:
David Whitrap, Express Scripts
314-517-3605
[email protected]

Jennifer Luddy, Express Scripts
908-794-9226
[email protected]

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SOURCE Express Scripts