US prescription drug spending up 13.1 percent in 2014, lifted by speciality medicines: report

According to a report published Tuesday by pharmacy benefit manager Express Scripts, prescription drug spending in the US climbed 13.1 percent in 2014, mainly driven by speciality medicines, including new therapies for hepatitis C. Express Scripts noted that the increase, which is the highest since 2003, follows years of moderate annual rises in drug spending of 6 percent or less.

"For the past several years, annual drug spending increases have been below the annual rate of overall healthcare inflation in the US," commented Glen Stettin, senior vice president of clinical, research and new solutions at Express Scripts. "But that paradigm is shifting dramatically as prices for medications increase at an unprecedented and unsustainable rate," Stettin added.

The report revealed that spending on specialty drugs jumped 30.9 percent last year, and despite accounting for only 1 percent of all US prescriptions, represented 31.8 percent of all drug spend, up from 27.7 percent in 2013. Express Scripts predicts that specialty drug costs will grow at a rate of more than 20 percent a year from 2015 to 2017.

The report revealed that hepatitis C therapies accounted for 45 percent of the total increase in specialty spending in 2014, with the US spending 742.6 percent more on hepatitis C medications last year than it did in 2013. Express Scripts forecasts that this will increase to 67 percent this year, due to the implementation of pricing control strategies.

Gilead Sciences received FDA approval for its hepatitis C drug Sovaldi (sofosbuvir) at the end of 2013, with the therapy priced at $84 000 for a 12-week treatment course. The company also gained clearance for its combination therapy Harvoni (ledipasvir/sofosbuvir), with AbbVie later receiving approval for its similar regimen Viekira Pak, which combines Viekira (ombitasvir/paritaprevir/ritonavir) and Exviera (dasabuvir), setting off a price war in the field. Gilead noted earlier this year that US discounts for its hepatitis C drugs would rise to an average of 46 percent this year, from 22 percent in 2014.

In December, Express Scripts reached an exclusive deal with AbbVie for Viekira Pak in exchange for a significant discount, with the pharmacy benefit manager excluding Harvoni for most patients. Stettin said that the company's clients that are using Viekira Pak are saving thousands of dollars per patient more than they would get with Gilead's 46 percent discount. Stettin refused to disclose what discount Express Scripts is getting from AbbVie. For related analysis, see ViewPoints: Gilead reveals the extent of AbbVie's pricing war in hepatitis C.

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