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Expensive Cancer, Heart Disease, Diabetes Drugs over the long run more expensive than HCV
  The payers are controlling healthcare, HCV is only 1 of numerous expensive diseases. Early in 2014 I said the payers complaints about HCV price was the first step, they were using HCV as a test case to see how far they could go because their real goal was to do the same if successful with all these other disease. the payers won, they now have gone onto cancer, heart disease & diabetes which are not curable, are long term or life time therapies & thus are much more expensive.....http://www.providencejournal.com/article/20150223/News/150229759
At the VHAC meeting last spring in Atlanta, I said from the panel I was sitting on with representatives from the payers, Matto Salo & the commercial group person Carmella, that these people are NOT your friends, but many in the audience did not criticize them.
I also said earlier in 2014 that the payers & medicaid's were launching a false public relations campaign about their costs hoisting up numerous untruths to make their case, out of that came the restrictions as everyone back in early 2014 bought this PR campaign & what it said rather than what affect it was having & the mischaracterizations they hoisted on the public. Its too late now, they won, the cat is out of the bag. The took on HCV drugs first because they were just being launched, it was a timing issue, now its on to cancer, new diabetes treatment because although not that expensive there are millions & increasing numbers with the gong population with diabetes, new expensive cholesterol drugs also expensive but also for a big market & of course very expensive cancer drugs that might extend life for as little as several months http://www.providencejournal.com/article/20150223/News/150229759
unlike the hepatitis C treatments, which offer a cure in as little as 12 weeks, PCSK9 inhibitors will be prescribed as ongoing maintenance therapy for the duration of patients' lives.".....injectable cholesterol treatments.....PCSK9 inhibitors .....belong to an experimental class of medicines.....cost $7,000 to $12,000 a year and patients could be on them for life.....Once the drugs are approved for broader use, the population taking them could grow to as many as 15 million people, according to CVS......Express Scripts is also setting its sights on cancer medications, where the latest drugs can cost as much as $150,000.
Spending on diabetes meds grew by 10.4% last year, mainly because of an 11% hike in drug prices. In fact, the diabetes category accounts for the biggest expense growth of any traditional drug class, a Prime Therapeutics report states. BlueCross BlueShield of Tennessee tells AIS Health that on a per-member basis, its diabetes treatment costs have grown by 33% from the first quarter of 2013 to the first quarter of 2014......Payers are worrying about new drugs coming down the pike, including the pricey SGLT2 inhibitors Invokana (canagliflozin) from Johnson & Johnson and Farxiga (dapagliflozin) from AstraZeneca Catamaran ($CTRX) has put these meds on prior authorization, and both it and Prime Therapeutics are hewing closely to requirements that patients try metformin before any other class of diabetes meds......http://www.fiercepharma.com/story/cost-conscious-payers-are-eyeing-higher-prices-diabetes-drugs/2014-07-22 unlike the hepatitis C treatments, which offer a cure in as little as 12 weeks, PCSK9 inhibitors will be prescribed as ongoing maintenance therapy for the duration of patients' lives.".....injectable cholesterol treatments.....PCSK9 inhibitors .....belong to an experimental class of medicines.....cost $7,000 to $12,000 a year and patients could be on them for life.....Once the drugs are approved for broader use, the population taking them could grow to as many as 15 million people, according to CVS......Express Scripts is also setting its sights on cancer medications, where the latest drugs can cost as much as $150,000
Private payers and government officials are spooked by the prospect of treating some 3 million patients infected with hepatitis C, at some $100,000 a shot, Express Scripts CMO Steve Miller said at a recent conference. So should they be about the PCSK9 class. "[T]hink about a lifetime drug that's probably going to cost greater than $10,000 annually times 71 million people," Miller said, citing the number of patients with high cholesterol. "Those are the problems we're going to face."
With a cadre of new cholesterol drugs on their way, expect to hear a lot more about "bad" LDL, "good" HDL and triglycerides. The PCSK9 class includes products from Amgen and Pfizer as well as the Sanofi/Regeneron drug, and all the companies will be working to make a new market. The specialty cholesterol drugs--injectable antibody treatments--will be pricey, and drugmakers face a job persuading doctors and payers that they're worth adding to statin therapy.........The problem with PCSK9 meds? They're not cures. They're treatments for chronic illness. So even at prices of $7,000 to $12,000 per person, they're still bound to be more costly, in the long run, than hepatitis C remedies, CVS figures......But how the dickens can CVS come up with $150 billion in PCSK9 spending?.......executives from CVS Caremark ($CVS) and Express Scripts ($ESRX), the two biggest U.S. PBMs, say these drugs are groundbreaking treatments that are proving safe and effective at controlling cholesterol in people who've had little success at that in the past. But at an estimated $10,000 per year, drugs like Sanofi and Regeneron's alirocumab, Pfizer's bococizumab, and Amgen's evolocumab won't fit the healthcare budget.
new cancer medicines as well as innovative drugs for other diseases coming to market,......Half of the about 30 cancer drugs introduced since 2010 cost $10,000 a month or more and all were at least $5,000 a month,......new class of cancer drugs, called PD-1 inhibitors, on the market for melanoma...... cost about $150,000 a year and are expected to be widely used......similar drugs in a class that analysts have projected could eventually generate as much as $40 billion in annual global sales......http://washpost.bloomberg.com/Story?docId=1376-NILE846KLVRI01-6R00HNRVMVCUON4SFEUNN09RQ8
http://www.prnewswire.com/news-releases/us-spending-on-hepatitis-c-medications-to-skyrocket-1800-percent-by-2016-254339691.html......Specialty Medications: increase in spending of 14 percent in 2013, diabetes was the costliest drug class for the third consecutive year......Increasing Costs for Small Patient Populations....inflammatory conditions, multiple sclerosis and cancer......inflammatory conditions, such as rheumatoid arthritis and Crohn's disease......entral nervous system disorders, which includes treatments for Huntington's disease, narcolepsy and Parkinson's disease.....Diabetes, high blood pressure and high blood cholesterol accounted for more than a quarter of total Part D spending......The costliest specialty condition for Part D in 2013 was cancer, followed by multiple sclerosis and inflammatory conditions Eight of the newly approved drugs during the past two years were for diabetes, including four last year: Farxiga (in January), Tanzeum (in April), Jardiance (in August), and Trulicity (in September). Those approvals followed FDA approvals in 2013 for Invokana, Kazano, Nesina, and Oseni.
Given that about 29 million Americans have diabetes - and that several manufacturers launched extensive promotional campaigns for their new diabetes drugs - large numbers of plan beneficiaries are already taking these drugs. However, all these drugs are far more expensive than the tried-and-true generic diabetes medications, including metformin and the three sulfonylureas (glyburide, glimepiride, and glipizide)......Drugs to treat cancer are also putting enormous financial pressures on health plans, patients, and their families. According to a recent newspaper investigation, the FDA approved 54 new cancer drugs during the past decade. Those drugs had an average monthly cost of $10,000, with four priced at more than $20,000 and one at $40,000 (Fauber 2014).......http://www.managedcaremag.com/archives/2015/1/when-it-comes-new-drugs-if-providers-and-payers-snooze-they-lose
In 2013, drug companies debuted 36 new drugs, including 10 notable cancer treatments, the most in more than a decade, the IMS report found. Other significant new drugs on the market included treatments for hepatitis C, multiple sclerosis and diabetes. Pharmaceutical companies began selling 17 drugs last year to treat so---called orphan diseases -those that affect fewer than 200,000 people nationwide.specialty drugs account for 17 percent of the average employer's overall pharmacy costs, but it's estimated they'll make up 40 percent of the average employer's overall pharmacy costs by 2020.
In 2013, it is reported that 23 percent of employer---sponsored health plans placed specialty drugs in their own group, or tier, in which consumers were asked to pay a percentage of the drug cost rather than a set co---payment. In ......http://www.lachamber.com/clientuploads/KP/073014_SpecialtyCareDrugs.pdf
Drug spending growth in 2014 was highest among Medicare plans, at 13.8%. Spending rose 13.1% in commercial plans, and 10.2% in Medicaid plans......The unit cost of Lantus, an insulin medication made by France's Sanofi SA, rose by a third on average, offsetting a 1.8% decline in patient use, according to the report. The unit cost of Gleevec, a cancer therapy made by Switzerland's Novartis AG , increased by an average of 19% in Medicare and commercial plans. The unit cost is the price of one pill or vial of medication.
Overall, unit prices rose on average by 12.4% across government and commercial health plans......Spending on specialty medications rose by an average of 38% across Medicare, Medicaid and commercial insurance plans, the company's report said.
Express Scripts forecasts spending among commercial plans will grow by an average of 10% annually from 2015 through 2017.
U.S. Prescription Drug Spending Increased 13.1 Percent in 2014, Driven by Hepatitis C and Compounded Medications


- The 2014 Express Scripts Drug Trend Report shows highest national spend increase over past decade. Excluding hepatitis C and compounded medications, drug spending increased 6.4 percent in 2014.
- More than 15 percent of Express Scripts' clients spent less on prescription drugs in 2014 than in 2013. Closely managed pharmacy plans spent nearly 30 percent less per member on traditional medications, reduced annual specialty drug spend increases by 32 percent.
- Express Scripts' hepatitis C solution will save clients more than $1 billion in 2015.
- Express Scripts' compound management solution eliminated 95 percent of compounded drug costs for participating plans.
March 10, 2015
ST. LOUIS, March 10, 2015 /PRNewswire/ -- New hepatitis C therapies with high price tags and the exploitation of loopholes for compounded medications drove a 13.1 percent increase in U.S. drug spending in 2014 - a rate not seen in more than a decade - according to new data released today in the 2014 Express Scripts (NASDAQ: ESRX) Drug Trend Report.


Hepatitis C and compounded medications are responsible for more than half of the increase in overall spending. Excluding those two therapy classes, 2014 drug trend (the year-over-year increase in per capita drug spending) was 6.4 percent.
Specialty medications - biologic and other high cost treatments for complex conditions, such as multiple sclerosis and cancer - accounted for more than 31 percent of total drug spending in 2014. As Express Scripts forecasted last year, specialty drug trend more than doubled in 2014, to 30.9 percent. Hepatitis C medications accounted for 45 percent of the total increase in specialty spend despite having the second lowest prescription volume among the top 10 specialty conditions. Medicare plans - required to follow Medicare Part D formulary guidelines - were the hardest hit, as their annual specialty drug spend increased 45.9 percent.
"For the past several years, annual drug spending increases have been below the annual rate of overall healthcare inflation in the U.S., but that paradigm is shifting dramatically as prices for medications increase at an unprecedented and unsustainable rate," said Glen Stettin, M.D., Senior Vice President, Clinical, Research and New Solutions at Express Scripts. "Now, more than ever, plans need to tightly manage the pharmacy benefit, implement smarter formularies, control compounded medication use and offer the right clinical support to ensure all patients are able to achieve the best possible health outcomes at a price our country can afford."
The U.S. spent nearly 743 percent more on hepatitis C meds in 2014 than it did in 2013. Express Scripts' hepatitis C solution, which makes Viekira Pak™ (ombitasvir/paritaprevir/ritonavir packaged with dasabuvir) available to all hepatitis C patients and guarantees successful completion of therapy through Accredo, is expected to save our clients $1 billion in 2015.
New treatments for hepatitis C are just one example of non-orphan drugs with orphan-drug price tags. Future pharmaceutical innovations, such as new cancer drugs and PCSK9 inhibitors for high blood cholesterol, will continue to challenge payers. Projected to command an annual cost as high as $10,000 per patient, and potentially reaching a patient population eventually as large as 10 million Americans, PCSK9 inhibitors alone could one day cost the U.S. healthcare system an estimated $100 billion per year.
Closely Managed Plans Mitigate Spend Increases
Express Scripts' solutions, including formulary and utilization management programs, and use of Express Scripts' home delivery pharmacy, help payers improve patient care and benefit affordability. More than 15 percent of Express Scripts' clients spent less, per capita, on prescription drugs in 2014 than in 2013.
A sub analysis of the Drug Trend Report found that, compared to payers with less managed pharmacy plans, payers that implemented four or more cost-management programs achieved nearly zero drug trend and spent nearly 30 percent less per member on traditional (non-specialty) medications, those which treat common chronic conditions, such as diabetes.
A similar analysis shows that the annual increase in specialty spending is 32 percent less for employers with a tightly managed specialty pharmacy benefit compared to employers with an unmanaged benefit. The study - which examined 851 clients, 20 percent of which employed no utilization management programs for specialty - also revealed that tightly managed programs saw higher average medication adherence rates in top specialty therapy classes, such as multiple sclerosis and pulmonary conditions.
Formulary Design Delivers Cost Savings with Low Member Impact
Many plan sponsors countered brand-drug price inflation by implementing the 2014 Express Scripts National Preferred Formulary, which excluded 48 products from coverage, achieved a 3.9 percent decrease in drug spending among the affected therapy classes, more than $750 million in savings. The excluded products represented only about 1 percent of all the products on the market, and in all cases, patients had safe and effective alternatives covered by their plan. Drug costs in those same therapy classes increased 7.2 percent among plan sponsors who did not adopt the new formulary.
Plans participating in the National Preferred Formulary in 2014, and continuing in 2015, have seen the number of patients impacted by formulary exclusions decline significantly, while realizing cumulative savings of more than $2.2 billion.
Compounded Medications Drive Increased Spending on Traditional Medications Spending on traditional classes of medications continues to rise as a result of compounded drugs, which emerged in the top 10 traditional therapy classes for the first time. Despite having the least number of prescriptions among the top 10 classes, compounded medications accounted for 35 percent of the increase in spending, the most of any traditional therapy class of drugs.
However, Express Scripts expects spend on compounded medications to decline sharply in 2015 due to widespread adoption of our compound utilization management solution. Implemented in mid-2014, this program will save clients more than $1.9 billion in 2015 that would have otherwise been wasted on compounded medications that do not provide a proven clinical benefit. "Express Scripts' actions to close the compound loophole provided our clients with a swift and effective solution to this costly concern," said Dr. Stettin. "There is no charge to clients for this new solution, only the benefit of a 95 percent reduction in waste associated with this category of medications. We ensure that patients who need compounds can access them; and where clinically appropriate, we ensure that patients who do not need these compounds can receive effective, more affordable alternatives."
Additional Key Findings
· Drugmaker consolidation and drug shortages
also led to increases in traditional drug trend, which rose to 6.4 percent in 2014.
· Diabetes remains the leading traditional therapy class for a fourth straight year based on total costs; Express Scripts expects double-digit increases in spend in this class over the next three years due to once-weekly oral and injectable drugs in the pipeline.
· Cost for medications to treat pain increased 15.7 percent in 2014, due in part to new tamper-resistant formulations for opiates.
· Inflammatory conditions, which include treatments for rheumatoid arthritis and psoriasis, maintained their position as the costliest specialty drug class due to expanded indications and increased prevalence of treatment.
As it has for the past two decades, the Express Scripts Drug Trend Report examines annual changes in utilization, unit costs and overall prescription drug spending, based on the pharmacy claims data from Express Scripts, the nation's largest pharmacy benefit manager. The full report is available online at http://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 ScienceSM, 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 Contact: Jennifer Luddy, Express Scripts 201-269-6402
SOURCE Express Scripts
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