The US healthcare system is currently facing challenging times as more and more pharmaceutical companies roll out new high-end drugs pushing the medication costs higher leaving employers, health plan providers and others to take the brunt, a new research has revealed.
According to data released by Express Scripts during its annual Outcomes Symposium, nearly 600,000 Americans have annual medication costs above $50,000 – a 63 per cent jump over 2013, while 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 the data released, nine out of ten 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 per cent 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.
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.
“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.”
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.”
Baby Boomers, ages 51-70, surpassed all other age groups as the highest-cost medication users, making up 58 per cent of the population with annual drug costs exceeding $100,000, an increase of 243 per cent 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.
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 per cent of their total 2014 pharmacy costs, reflecting an annual decrease in the out-of-pocket percentage these patients pay.
