As specialty drugs continue to dominate pharmacy spending growth, oncology medications continue to assume a leading role. While a wide variety of anti-cancer medications entered the market in 2019, expensive specialty oncology drugs such as checkpoint inhibitors accounted for an outsized percentage of cancer drug claim costs -- despite being only a small percentage of claims volume.
Personalized treatments such as CAR T-cell therapy, which genetically engineers a person’s own T-cells to fight cancer, also gained wider acceptance in 2019. These new treatments can be highly effective, but come at a high cost.
Spending on hemophilia treatments has long outpaced the relative rarity of the condition – and the scarcity of treatments. That began to change in 2019, as people with hemophilia saw several new treatment options. For example a new drug, Hemlibra® (generic name), can be used by people with hemophilia A to prevent bleeding episodes before they start.
In addition, potential one-time gene therapies for hemophilia continued to advance in clinical trials during the year.
A truly novel approach aimed at patients with major, treatment-resistant depression emerged in 2019. Spravato™ (generic name) received FDA approval to treat people who have tried other antidepressant medicines but have not benefited from them. The drug’s approval comes with some clinical controversy, as it is the chemical mirror of ketamine, an anesthetic that has been commonly abused recreationally and can lead to significant side effects.
As a branded drug, Spravato is far more expensive than existing depression treatments by thousands of dollars per month. This could be a shock in a drug class where prices have been falling, as older brand-protected medications are losing their exclusivity and generic use is approaching 100%.
Innovation in pharmacy is not limited to the medicines themselves. With PreCheck MyScript®, we have made dramatic improvements to the prescribing process itself. New data confirms that by increasing the ease and transparency of the prescribing process, PreCheck MyScript is creating a better experience for clients, members, physicians and pharmacies.
By giving doctors real-time knowledge of all drugs covered by the patient’s benefit plan, PreCheck MyScript can directly lower client and member costs by suggesting lower-cost alternative drugs. For example, PreCheck MyScript helped clients save an average of $415 per prescription filled.1
Lighting the road ahead
Our customers look to OptumRx for timely insights into the pharmaceutical pipeline. Our quarterly pipeline reports, prepared in collaboration with a team of our clinical experts, gives clients the advance warning needed on the pipeline products we think will have a significant market impact.
1. Third party analysis of OptumRx claims data. July 2017 - November 2018 based on 2.6 million members, >110,000 providers, and 13.3 million transactions using
STATEMENT REGARDING FINANCIAL INFLUENCE:
This article is directed solely to its intended audience about important developments affecting the pharmacy benefits business. It is not intended to promote the use of any drug mentioned in the article and neither the author nor OptumRx has accepted any form of compensation for the preparation or distribution of this article.
Tag: Specialty pharmacy, Complex conditions, Total cost management, Articles and blogs, Pharmacy care services, Physician engagement, Rx resources