Top 10 Drug Spending Categories by Traditional Therapeutic Class

Pharmacists should be aware of the latest drug trend report from the nation’s largest pharmacy benefits manager to better inform patients of any shifts in pricing.

Express Scripts recently released its 2015 Drug Trend Report, a detailed analysis of US prescription drug costs and utilization rates.

Overall, the total amount of money spent on traditional therapeutic classes increased by a modest 0.6% last year. Broken down by class, however, the data were more extreme.

The following are the top 10 nonspecialty drug spending categories for 2015, ranked by Express Scripts’ per member per year (PMPY) spending calculations.

1. Diabetes

Average Cost Per Prescription: $94.21

PMPY spending on diabetes medications was $77.50 in 2015, representing a 14% overall increase from 2014 that was driven by increases in both utilization (6.7%) and unit cost (7.4%).

About 53% of diabetes prescriptions dispensed in 2015 were for generic medications, and the top drugs by market share dispensed in this category were metformin, insulin glargine (Lantus Solostar), glipizide, glimepiride, and insulin lispro (Humalog). Lantus Solostar ranked 5th among the 10 best-selling brand-name drugs in 2015.

2. Pain/Inflammation

Average Cost Per Prescription: $38.36

PMPY spending on pain/inflammation drugs was $40.65 in 2015, representing a mere 2.9% overall increase from 2014.

Last year marked the first time Express Scripts combined opioids, nonsteroidal anti-inflammatory drugs, and gamma-aminobutyric acid analogs into a combined pain and inflammation class. This consolidation pushed the therapeutic class into the second-highest spending category for 2015.

Notably, drug spending trends in this class reflect both the reclassification of certain drugs as controlled substances and the growing availability of generics.

Generic versions of Celebrex became available in December 2014, and nearly all prescriptions for the drug were written for the generic thereafter. This likely contributed to the 2.1% overall reduction in unit cost across the pain and inflammation class.

Despite the growing availability of generic versions, 2 brand-name drugs accounted for the highest spending in this category: Lyrica and the reformulated Oxycontin ER. Lyrica increased 19.8% in spending last year, and the drug ranked 10th on IMS Health’s list of 10 best-selling brand-name drugs in 2015.

The top drugs dispensed in this category by market share in 2015 were hydrocodone/acetaminophen, gabapentin, meloxicam, tramadol, and ibuprofen.

3. High Cholesterol

Average cost per prescription: $29.78

PMPY spending on high cholesterol medications in 2015 was $32.66, representing a 9.2% overall decrease in spending from 2014.

Last year, the generic fill rate for high cholesterol drugs was 83.1%. Going forward, spending in this category should continue to decrease, as many of the top-prescribed drugs for high cholesterol are generic therapies projected to continue decreasing in unit cost.

The top drugs in this therapeutic class by market share in 2015 were atorvastatin, simvastatin, pravastatin, rosuvastatin (Crestor), and fenofibrate. Crestor ranked 4th among the 10 best-selling brand-name drugs in 2015.

4. Attention Disorders

Average cost per prescription: $125.96

PMPY spending on prescription drugs for attention disorders was $29.44 in 2015, representing an 8.5% overall increase from 2014. Utilization also increased by 5.9% in 2015, reflecting increased use among adults, including the elderly.

The generic fill rate for this therapeutic class was 73.8% in 2015, and the top drugs dispensed by market share were amphetamine/dextroamphetamine, methylphenidate extended release, lisdexamfetamine (Vyvanse), dexmethylphenidate extended release, and atomoxetine (Strattera).

Drug spending for brand-name Vyvanse is unlikely to decrease in the near future, as its manufacturer has secured patent protection for the drug through at least 2023. The drug also received expanded approval in January 2015 to treat binge-eating disorder.

Notably, the first generic version of the nonstimulant attention disorder treatment guanfacine (Intuniv) became available in 2014, followed by 4 more generic versions in June 2015.

5. High Blood Pressure/Heart Disease

Average cost per prescription: $10.45

PMPY spending on high blood pressure and heart disease medications was $25.70 in 2015, representing a 12.5% overall decrease from 2014.

Express Scripts noted that this decrease in drug spending mostly stems from the decline in overall unit cost, which dropped by nearly 15% in 2015. The slight increase in utilization (2.4%) is “possibly due to the affordability within the class.”

The high blood pressure and heart disease therapeutic class has the highest generic fill rate (95.7%) of the top 10 categories. The top drugs dispensed by market share in 2015 were lisinopril, metoprolol succinate, amlodipine, hydrochlorothiazide, and losartan.

6. Heartburn/Peptic Ulcer Disease

Average cost per prescription: $43.14

PMPY spending on heartburn and peptic ulcer medications was $23.95 in 2015, representing a 35.6% overall increase from 2014.

Despite this staggering increase, Express Scripts projected that “the availability of generic Nexium (esomeprazole) in February 2015 and some shift to OTC Nexium should result in lower overall unit cost increases for the class.”

Nexium ranked 8th among the 10 best-selling brand-name drugs in 2015.

The market for the heartburn and peptic ulcer disease class is dominated by generics and has a generic fill rate of 92.3%. The top drugs by market share in 2015 were omeprazole, pantoprazole, esomeprazole, ranitidine, and lansoprazole.

7. Mental/Neurological Disorders

Average cost per prescription: $199.62

PMPY spending on mental and neurological disorder drugs in 2015 was $23.28, representing a mere 0.2% overall increase from 2014.

This trend was influenced by a small increase in utilization (2.4%) that was offset by a small decrease in unit cost (-2.2%).

The generic fill rate in the mental and neurological disorder class was 78.4% in 2015. Brand-name drugs such as Namenda, Abilify, and Seroquel saw moderate increases in unit cost of 5.7%, 4.9%, and 6.7%, respectively.

The top drugs in this therapeutic class by market share in 2015 were quetiapine, aripiprazole, risperidone, donepezil, and lithium. Although generic Abilify appeared on Express Scripts’ top 5 drugs by market share in this therapeutic space, branded Abilify was still ranked No. 2 among the 10 best-selling brand-name drugs in 2015.

8. Asthma

Average cost per prescription: $51.37

PMPY spending for asthma medications was $22.72 in 2015, representing a 1.6% overall decrease from 2014.

The generic fill rate for this therapeutic class was 42.7%, and the top drugs by market share were montelukast, albuterol (ProAir HFA, Ventolin HFA), budesonide/formoterol fumarate dihydrate (Symbicort), and flutiacasone/salmeterol (Advair Diskus).

The generic version of Singulair comprised 33.6% of the asthma medication market share. The remaining 4 of the top 5 were brand-name inhalers.

As asthma prevalence continues to rise, “spend for branded inhalers will increase,” Express Scripts noted in its report. Advair Diskus ranked 7th among the 10 best-selling brand-name drugs in 2015.

9. Compounded Drugs

Average cost per prescription: $1182.83

PMPY spending for compounded drugs was $20.62 in 2015, representing a 53.9% overall decrease from 2014.

Compounded drug costs spiked after 2012, when new regulations required all components of compounded drugs to be specified and billed at the ingredient level. As a result, “bulk manufacturers and compounding pharmacies raised prices substantially for many components of compounded medications, resulting in much higher drug spend in 2014,” Express Scripts noted.

Uptake of compound management solutions led to the 53.9% decrease for PMPY spending in 2015.

The generic fill rate for compounded drugs is 36.4%, and the top drugs by market share in 2015 were gabapentin, micronized progesterone, lidocaine hydrochloride viscous solution, propylene glycol, and baclofen.

10. Skin Conditions

Average cost per prescription: $136.61

PMPY spending for skin condition medications was $20.18 in 2015, representing a 27.8% overall increase from 2014.

Express Scripts attributed the majority of this increase to the 2 most-used drugs in the class—generic corticosteroids clobetasol and triamcinolone—which increased in unit cost last year by 96.2% and 28%, respectively.

The generic fill rate for this therapeutic class was 86.3%, and the top drugs by market share in 2015 were triamcinolone, clobetasol, hydrocortisone, fluocinonide, and betamethasone.