The trend in specialty drug cost increases moderated a bit in 2020, but a new report finds that this was probably due in part to the COVID-19 pandemic, which delayed or deferred some care. The report predicts continued increases in costs for specialty medications in coming years.
Growing utilization of these expensive drugs will drive the trend higher in the future, according to the report. The study was released by Artemetrx, an integrated data technology platform that is part of Pharmaceutical Strategies Group, a pharmacy benefits consulting firm.
“For the first time in five years, specialty trend moderated considerably in 2020, falling to 11.8% from the 14.8% seen in 2019,” the report said. “The slowing trend is likely due to a combination of factors, including delayed and deferred diagnostic care during the SARS-CoV-2 (COVID-19) pandemic,1 drug mix, increased use of biosimilars, and the availability of additional specialty generics.”
The report noted that high-priced specialty pharmaceuticals have had an upward trend in costs, but that some variation has been found.
For example, the per-member-per-year (PMPY) cost for specialty drugs was on average, $959, an increase of $101 compared with $111 from the prior year. However, specialty costs trends for plan sponsors working with Artemetrx ranged from $587 PMPY, a -1.9% trend, to $1,065 PMPY, a 20.8% increase.
“Trend differences by plan sponsors can be due to both the level of specialty drug management (such as plan design, channel management, and clinical utilization management programs), drug mix, reimbursement, utilization, and member demographics, among other factors,” the report said.
Claims utilizing drove the trend, with 9% of the 11.8% trend in 2020 due to increased claim utilization, and 2.6% due to changes in costs.