Express Scripts Last Wednesday during its annual Outcomes Symposium launched a report regarding pharmaceutical companies initiating costly cancer drugs, and introducing new cures for hepatitis which are very expensive to say the least. Medications cost for larger populations, employers, health plans and others have kicked off to a whole new level.
Alarmingly true that 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. Although hard to believe, 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.
According to a research by Glen Stettin, M.D., Senior Vice President, Clinical, Research and New Solutions at Express Scripts, there seems to be a clear pattern of patients who overwhelmingly take special medications, and have multiple co morbidities, prescriptions and prescribers. This tendency presents opportunities for payers to work with their PBM to improve care, health and overall quality of life for the patients who rely on these costly, complex therapies.
According to the pharmacy benefits manager of Express Scripts more than half a million Americans last year took home around $50,000 worth of prescription drugs each while super-high spenders prescribed $100,000 or more worth of medications nearly tripled from 47,000 to 139,000. The people in this category are usually very sick people. More than one-third of the patients, whose drug costs reached at least $100,000, were treated for at least 10 different conditions and more than 60 percent were taking 10 different prescription medications.
Express Scripts also found that patients who are spending $100,000 or more annually, specialty, made-to-order drugs known as compounded therapies, as well as drugs for hepatitis C and to treat cancer accounted for two-thirds of the costs.
Gilead Science’s Sovaldi, is included in hepatitis C drugs which can cure the virus responsible for destroying liver. Gilead charges $84,000 for the three month long drug course, and according to him, this is cheaper than treating patients for a lifetime of liver disease.
Over the years Express Scripts, has tirelessly fought the drug companies regarding their pricing. They refused to cover Gilead’s other expensive hepatitis C drug Harvoni, and instead negotiated a deal with Abbvie to get its hepatitis C drug Viekira at a considerably lower rate.
Patients with terminal melanoma can be kept alive for a year or longer using Bristol-Myers Squibb’s melanoma drug Yervoy but it costs $120,000 for a single course of treatment.
In 2014 insurance plans covered approximately 98 percent of the costs for patients whose drugs cost $100,000 or more. Patients almost never bear these high costs.
