Specialty trend maintains double-digit growth as more specialty drugs enter market despite growing prevalence of biosimilars

Pharmaceutical Strategies Group (PSG), an EPIC company, has released its highly anticipated Artemetrx^® State of Specialty Spend and Trend Report. The sixth-annual report uses integrated pharmacy and medical claims data to formulate a holistic view of specialty spend and trend. Since its inception in 2017, it has served as the only comprehensive analysis of specialty drug spending, powered by the industry’s leading integrated dataset through Artemetrx.

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2016 vs. 2021: Shift in Specialty Trend Spend (Graphic: Business Wire)

“Specialty trend returned to a pre-pandemic level in 2021, rebounding to 14.2%,” said Michael Lonergan, RPh, President of PSG. “However, it is encouraging to see competition from biosimilars impact cost. We saw an overall increase in utilization, from 12.4% in 2020 to 22.5% in 2021 and expect more meaningful impact as biosimilars for Humira enter the market next year.”

As with 2020, claim utilization continues to drive trend. In fact, 9.4% of the 14.2% 2021 trend was due to increased claim utilization and 4.4% due to changes in cost per claim. Thus, while very high-cost therapies capture the spotlight, utilization is driving the specialty trend. We anticipate that as new costly therapies for higher prevalence diseases such as migraines and asthma are introduced, the double-digit trend will likely continue.

“While the definition of what comprises specialty drugs has shifted since the inception of this report six years ago, the importance of proactive specialty drug program management has not changed,” said Renee Rayburg, RPh, Vice President of Specialty Clinical Consulting. “Our data supplies the needed precision to track trend drivers and keep pace with the rapidly changing market complexities, allowing for the construction of appropriate plan strategies,” commented Rayburg. “Access to integrated data creates the ability to align PBM and health plan strategies to achieve the maximum financial benefit.”

“The Artemetrx Specialty Spend and Trend report is an important tool to aide in the assessment and design of specialty pharmacy strategy,” noted Timothy Carroll, PharmD – VP, Business Development and Analytics, Reliance Rx. “It becomes more essential as new therapies, generics and biosimilars are introduced and paradigms are continually shifting.”

Key takeaways from the Spend and Trend Report include:

• Inflammatory conditions remain the top category and Humira the top drug in terms of overall plan cost. As biosimilars and specialty generics enter the market in 2023, this could shift.
• The percentage of specialty spend in the medical versus pharmacy benefit is 64.5% pharmacy / 35.5% medical – reflecting a return to 2016 percentages.
• Specialty drug plan cost continues to grow rapidly, reaching $1,295 per member per year (PMPY) – double the cost compared to 2016.
• After a reduced trend of 11.8% from 2019-2020, likely pandemic-related, specialty trend from 2020-2021 rebounded to 14.2%.
• Stabilizing at 4.8% for 2019 and 2020, the percentage of the population utilizing at least one specialty drug increased to 5.9% in 2021.

The 2022 State of Specialty Spend and Trend Report continues to reflect PSG’s legacy of relentless client advocacy with perspectives on how payers and plan sponsors can transform insights into opportunities.

Follow this link to access the full report: https://www.psgconsults.com/specialtyreport2022

About Pharmaceutical Strategies Group (PSG)

Pharmaceutical Strategies Group, an EPIC company, relentlessly advocates for clients as they navigate complex and ever-changing drug cost management challenges. PSG’s innovative drug management solutions, including the proprietary data and analytics platform, Artemetrx®, deliver actionable insights with exceptional financial and clinical value. PSG functions as a strategic partner through industry-leading intelligence and technologies to realize billions of dollars in drug cost savings for clients every year. https://www.psgconsults.com/

About Artemetrx^®

Artemetrx is a proprietary SaaS platform developed by PSG, an EPIC company. As one of the first technology solutions in the market to integrate pharmacy and medical claims data for specialty drug cost management, Artemetrx continues to provide market-leading specialty drug insights to payers. It delivers unparalleled intelligence and line-of-sight into serious challenges perpetuating out-of-control drug costs and compromised patient outcomes. PSG’s innovative drug management solutions, including Artemetrx, deliver actionable insights with exceptional financial and clinical value. PSG functions as a strategic partner through industry-leading intelligence and technologies to realize billions in dollars in drug cost savings for clients every year. https://www.psgconsults.com/discoverartemetrx

About Reliance Rx – Report Sponsor

Reliance Rx offers national specialty pharmacy fulfillment and care coordination of complex disease states - resulting in greater efficiency, lower costs and improved services. Through enhanced communication between physicians, patients and its specialty pharmacy, Reliance Rx aims to achieve maximum appropriate therapy adherence and promote positive clinical outcomes. Providing the best possible care drives everything they do, from a truly personalized experience to the effective delivery of specialty pharmacy services. https://www.reliancerxsp.com/.

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