Prescription Drug Utilization and Cost Trends,

Transcription

1 Agenda Item 7 Attachment 1 Prescription Drug Utilization and Cost Trends, Pension and Health Benefits Committee October 14, 2014 Melissa Mantong, PharmD CalPERS Pharmacist

2 Overview Trends in prescriptions and costs Generic dispensing trends 2013 costs by prescription drug type Specialty drug trends 2

3 Number of Prescriptions and Cost Per Prescription Number of Prescriptions (millions) $88.48 $91.28 $89.12 $90.78 $ $100 $90 $80 $70 $60 $50 $40 $30 $20 $10 $0 Per Prescription Number of Prescriptions (millions) per Prescription 3

4 Cost per Prescription and Number of Prescriptions - Annual Changes 6% 4.88% 4% 2.70% 3.16% 2% 1.66% 1.86% 0% 0.22% -0.57% -2% -2.36% -4% Number of Prescriptions per Prescription 4

5 Cost Per Days Supply and Number of Days Supply 800 $ $1.97 $2.00 $2.05 $2.01 $2.06 $2.00 Number of Days Supply (millions) $1.50 $1.00 $0.50 per Days Supply $0.00 Number of Days Supply (millions) per Days Supply 5

6 Cost per Days Supply and Number of Days Supply - Annual Changes 8% 6% 5.64% 4% 2% 1.96% 2.29% 2.52% 2.78% 0% 0.06% -2% -2.20% -1.47% -4% Number of Days Supply per Day Supply 6

7 Generic Dispensing Trends by Plan Percent Prescriptions That are Generic 85% 80% 75% 70% 65% 60% 75.5% 71.5% 61.3% 77.7% 78.2% 77.0% 74.5% 67.0% 64.5% 80.4% 78.8% 73.6% 83.2% 83.1% 76.3% 55% 50% Kaiser (HMO) Blue Shield (HMO) PPO Includes Basic and Medicare members. PPO includes PERSCare, PERS Choice, and PERS Select. 7

8 2013 Costs by Prescription Drug Type Non-Specialty Brand Generic Specialty Multi-Source Single Source Total Number of Prescriptions 13,269, ,016 1,773,114 93,729 15,932,360 (millions) $404 $114 $681 $298 $1,497 Member Cost Share (millions) $87 $15 $62 $3 $168 per Prescription Member Cost Share per Prescription $30.44 $ $ $3, $90.78 $6.58 $19.47 $35.16 $29.27 $10.58 Member Cost Share % 21.6% 13.7% 9.1% 0.9% 11.2% 8

9 2012 Top Ten Non-Specialty Drugs Drug Name Primary Indication (millions) Prescription Non-Specialty Drugs Allowed Amount NEXIUM Stomach Ulcer $ % 2.61% ATORVASTATIN CALCIUM High Cholesterol $ % 1.97% CYMBALTA Depression $ % 1.91% ABILIFY Bipolar Disorder $ % 1.90% OXYCONTIN Pain $ % 1.48% CRESTOR High Cholesterol $ % 1.37% DIOVAN Hypertension $ % 1.26% ADVAIR DISKUS 250/50 Asthma $ % 1.26% SINGULAIR Asthma $ % 1.25% JANUVIA Diabetes $ % 1.19% Total Top Non-Specialty drugs $ % 16.21% 9

10 2013 Top Ten Non-Specialty Drugs Drug Name Primary Indication (millions) Prescription Non-Specialty Drugs Allowed Amount NEXIUM Stomach Ulcer $ % 2.46% ABILIFY Bipolar Disorder $ % 2.21% CYMBALTA Depression $ % 2.20% CRESTOR High Cholesterol $ % 1.47% OXYCONTIN Pain $ % 1.36% ADVAIR DISKUS 250/50 Asthma $ % 1.29% JANUVIA Diabetes $ % 1.27% DIOVAN Hypertension $ % 1.20% ATORVASTATIN CALCIUM High Cholesterol $ % 1.14% ANDROGEL Hypogonadism $ % 1.12% Total Top Non-Specialty drugs $ % 15.72% 10

11 Specialty Drugs Number of Specialty Drug Prescriptions Specialty Drug Prescriptions as a % of Total Prescriptions Specialty Drug (millions) Specialty Drug as % of Total Specialty Drug Member Cost Share Amount (millions) Specialty Drug Member Cost Share % 2009* 2010* 2011* 2012** 2013** 59,177 64,960 69,324 81,276 93, % 0.40% 0.42% 0.49% 0.57% $146 $175 $209 $254 $ % 12.2% 13.9% 17.3% 19.9% $1.34 $1.48 $1.69 $2.22 $ % 0.84% 0.81% 0.87% 0.92% * Based on Medco Specialty Drugs list. ** Based on 2012 and 2013 CVS Caremark Specialty Drugs lists. 11

12 2012 Top Ten Specialty Drugs Drug Name Primary Indication (millions) Prescription Specialty Drugs ENBREL Rheumatoid Arthritis $ % 13.51% HUMIRA Rheumatoid Arthritis $ % 10.78% COPAXONE Multiple Sclerosis $ % 8.96% REVLIMID Cancer $ % 6.68% GLEEVEC Cancer $ % 4.03% AVONEX Multiple Sclerosis $ % 4.02% INCIVEK Hepatitis C $ % 2.91% XELODA Cancer $ % 1.89% REBIF Multiple Sclerosis $ % 1.88% NEUPOGEN Neutropenia $ % 1.83% Total Top 10 Specialty Drugs $ % 56.49% List of specialty drugs based on 2012 CVS Caremark Specialty Drugs list. 12

13 2013 Top Ten Specialty Drugs Drug Name Primary Indication (millions) Prescription Specialty Drugs ENBREL Rheumatoid Arthritis $ % 13.24% HUMIRA Rheumatoid Arthritis $ % 11.83% COPAXONE Multiple Sclerosis $ % 8.07% REVLIMID Cancer $ % 5.65% GLEEVEC Cancer $ % 4.33% AVONEX Multiple Sclerosis $ % 2.58% ZYTIGA Cancer $ % 1.78% NEUPOGEN Neutropenia $ % 1.74% REBIF Multiple Sclerosis $ % 1.74% GILENYA Multiple Sclerosis $ % 1.72% Total Top 10 Specialty Drugs $ % 52.67% List of specialty drugs based on 2013 CVS Caremark Specialty Drugs list. 13