Top Ten Traditional Therapy Classes for 2015

Although there have been changes in the top 10 traditional therapy classes, diabetes still remains the leading therapy class with the highest cost ($77.50) when ranked by per member per year (PMPY) for the fifth consecutive year, according to the annual Express Scripts Drug Trend Report.

The report analyzes US prescription medication costs and utilization, with marketplace factors that impact future changes. The top 3 classes by spend contributed more than 25% of the total traditional drug spend in 2015, while the total trend reflected negatively for 4 of the top classes.

Below are the top 10 traditional therapy classes for 2015:

10. Skin conditions

Due to a 26.4% increase in the unit cost of medications for brand and generic therapies, skin condition medications had the second biggest overall trend at 27.8%. Six of the top 10 drugs for skin conditions are generic, of which 8 increased in unit price, with 5 of these increasing by 40%. Additionally, mergers and acquisitions of manufacturers led to a much less competitive marketplace for this class.

9. Compound drugs

This class appeared among the top 10 traditional therapy classes for the first time and ranked at third in overall spending. Regulations put in place in 2012 for a compound management solution caused utilization to drop 55.7% in 2015. These solutions also yielded a 53.9% decrease in PMPY spend for compounded drugs in 2015.

8. Asthma

This class shifted down to the eighth most expensive traditional therapy. Spend decreased by 1.6%, with a 5.8% increase in utilization that was offset by a 7.5% decrease in unit cost.

7. Mental/neurological disorders

There was only a slight increase in utilization that was offset by a small decrease in unit cost, leaving the overall trend at 0.2%. Bipolar disorder therapies and mood stabilizers accounted for the increase in trend. These cost trends were also influenced by the availability of generic drugs.

6. Heartburn/ulcer disease

Drugs to treat these diseases were shown to have the largest total trend this year at 35.6%, which was heavily influenced by the increase in unit cost (36.3%). Furthermore, this class consists of mostly generic medications. The increase in branded products like esomeprazole (Nexium), dexlansoprazole (Dexilant), and lansoprazole (Prevacid) influenced the price per unit trend.

5. High blood pressure/heart disease

Spend for these medications decreased by 12.5% and was heavily influenced by a 14.9% drop in unit cost. This is the second straight year this class saw a decrease in spend. Generic medications for high blood pressure and heart disease accounted for 95.7% of total market share. The amount of PMPY prescription medications was the highest among the top 10.

4. Attention disorders

Spend for these medications increased by 8.5%, which was largely driven by a 5.9% increase in utilization and a 2.5% increase in unit cost. The increased utilization in 2015 reflected greater use among adults and the elderly.

3. High blood cholesterol

In 2015, medications in the class declined in spend by 9.2%, causing it to drop to the third therapy class, despite sitting at number 2 for the last decade. The medications within this class mostly consist of generic therapies — 83.1% of the market share – and are still continuing to decrease in unit price. Utilization was nearly stable with a decline of only 0.3%, while conventional generic therapies like statins decreased. The utilization for omega-3 acid ethyl esters increased by 57.8% in plan cost, which influenced the utilization trend by 78.2% with a -20.4% unit cost trend.

2. Pain/inflammation

This class ranked with the second highest cost in 2015, which reflects the consolidation of nonsteroidal anti-inflammatory drugs (NSAIDS), gamma-aminobutyric acid (GABA) analogs, and opioids within the class. The overall increase in PMPY spend was only 2.9% and was influenced by small increases in unit cost (2.1%) and utilization (0.8%).

1. Diabetes

The trend for diabetes was 14% overall and was influenced by an increase in utilization and unit cost, mostly because diabetes is a chronic condition. Two new therapy drivers for these increases were canagliflozin (Invokana) and sitagliptin/metformin (Janumet). The utilization for the diabetes category is expected to continue to increase, especially for patients who use multidrug regimes. However, the lack in available generic drugs has an effect on the brand inflation continuing to drive the increase in the unit cost of diabetes medications.