PHARMACY

BCBS: Specialty drugs behind higher Rx spend

BY Michael Johnsen

CHICAGO – U.S. prescription-drug spend in 2014 reached $373.9 billion — a 13% increase from the previous year and the largest increase in more than a decade, Blue Cross Blue Shield reported, as more effective and expensive new specialty drugs came to market and existing specialty drugs saw prices increase. T
 
Recent analysis of data from BCBS companies, the largest commercial claims database in healthcare, confirms this broader trend. BCBS companies’ data reveal that prescription drug per-member per-month spend increased by 9.3% from 2013 to 2014. This growth outpaced even the substantial rise in outpatient costs, and it far exceeded growth in inpatient and other professional costs. More importantly, this rise in pharmaceutical spend also runs counter to other trends, such as greater use of less-expensive generic drugs. For example, in 2014, consumers chose generic drugs 67.7% of the time when a branded counterpart was available versus just over half (54.9%) of the time in 2012.
 
The driving factor behind the pharmaceutical cost trend is the cost of specialty drugs, BCBS concluded. Data confirm that in 2014, specialty drug unit costs jumped 20.1%, compared to 5.7% for non-specialty drugs. Utilization for specialty drugs also rose by 7.3% in 2014. 
 
Within the specialty pharmaceutical portfolio, the top 10 drugs contributed to 61% of overall spend. New Hepatitis C and Multiple Sclerosis drugs have contributed significantly to the trend, such as Sovaldi, a Hepatitis C treatment introduced in October 2014 that was priced at $84,000 for 12 week treatment, and Tecfidera for Multiple Sclerosis was priced at $55,000 for a 1 year treatment.
 
Macro trends, such as increasingly complex manufacturing processes and extended patent life, point to continued high unit costs for these drugs in the coming years, BCBS suggested. As a result, specialty drugs’ 23% current share of total prescription spend can only be expected to rise.
 
In response, BCBS Plans are actively implementing programs that make specialty drugs more affordable and that improve quality outcomes for members based on clinically-proven evidence, including:
 
Developing drug lists (i.e. formularies) and benefit designs, encompassing both medical and prescription benefit programs, that inform members of their treatment and medication options and the most appropriate drugs based on quality outcomes;Guiding patients to higher-quality, lower-cost healthcare providers; andPartnering with pharmacy benefit management companies focused on care coordination and medication management (e.g., appropriate usage, dosage and maintenance of specialty drugs).
 
keyboard_arrow_downCOMMENTS

Leave a Reply

No comments found

TRENDING STORIES

Polls

Which area of the industry do you think Amazon's entry would shake up the most?
PHARMACY

Digital pharmacy PillPack may open storefront near you

BY Michael Johnsen

BOSTON — Pharmacy startup PillPack is looking to augment its online pharmacy operation with brick-and-mortar locations with the infusion Wednesday of $50 million in financing led by CRV with participation from Accel Partners, Atlas Venture, Menlo Ventures and Sherpa Ventures. 
 
In addition to establishing a retail footprint in the U.S. market, the capital will be used to fuel growth and attract high-caliber talent, the company stated. 
 
"In the last two years, we've built and launched a better, simpler pharmacy experience that folks absolutely love," stated TJ Parker, CEO of PillPack. "With this funding, we're excited to expand our physical footprint across the country, enabling both increased capacity as well as opportunities for an even more delightful experience for our customers."
 
PillPack is a full-service pharmacy designed to simplify the process of managing multiple medications through a combination of personalized service, convenient packaging and technology. PillPack ships personalized rolls of pre-sorted prescriptions, vitamins and OTCs, in individual packs, and the company manages refills for customers by proactively coordinating with physicians and insurance providers.
 
PillPack has seen tremendous growth, shipping more than 1 million dose packs since the company's launch in February 2014. 
 
"In the last ten years, nearly every industry has been modernized to cater to its customers through convenience, service and simplicity. Surprisingly, the pharmacy experience has been completely overlooked," said George Zachary, partner at CRV. "I was drawn to PillPack because they've taken on this challenge. Anyone who has to deal with the hassles of an in-person retail pharmacy can understand its value, especially people who have to manage multiple prescriptions of their own or for their loved ones. It's truly transformative."
 
Zachary will take a director seat on the PillPack board, joining Fred Destin from Accel Partners, Jon Karlen from Atlas Venture and David Frankel from Founder Collective. PillPack has raised $62 million dollars to date.
 
PillPack is currently available in 47 states. The company accepts most prescription drug insurance plans, including a majority of Medicare Part D plans. 
keyboard_arrow_downCOMMENTS

Leave a Reply

No comments found

TRENDING STORIES

Polls

Which area of the industry do you think Amazon's entry would shake up the most?
PHARMACY

Mylan launches generic Seasonique

BY David Salazar

PITTSBURGH — Mylan announced on Tuesday that it had launched its generic version of Teva’s Seasonique birth control (Levonorgestrel and Ethinyl Estradiol Tablets USP, 0.15 mg/0.03 mg and Ethinyl Estradiol Tablets USP, 0.01 mg). The medication saw some $160.7 million in sales in the 12 months that ended on March 31 of this year. 
 
The launch follows the Food and Drug Administration’s approval of Mylan partner Famy Care’s abbreviated new drug application for the drug. Mylan has 271 ANDAs still awaiting FDA approvals, 47 of which are first-to-file opportunities. 
 
 
keyboard_arrow_downCOMMENTS

Leave a Reply

No comments found

TRENDING STORIES

Polls

Which area of the industry do you think Amazon's entry would shake up the most?