As drug costs rise, a few bright spots appear for payers

Even though a new report shows drug spending increased in 2015, it also offers evidence that health insurers' efforts to push back against climbing costs are having an effect.

Overall, total spending on prescription drugs in the U.S. reached $424.8 billion in 2015, an increase of 12.2 percent from 2014, according to a report from the IMS Institute for Healthcare Informatics. Spending adjusted for net prices reached $309.5 billion, an increase of 8.5 percent over 2014.

Yet the report estimates that the average net price for brands already in the market is estimated to have increased by just 2.8 percent in 2015, down from a 5.1 percent rise in 2014 and "significantly lower" than seen in prior years. "This reflects the heightened competition among manufacturers and more aggressive efforts by health plans and pharmacy benefit managers to limit price growth," the report says.

It's not all good news for insurers, however. New treatments for hepatitis, cancer, diabetes and other chronic conditions drove $24.2 billion of new spending growth in 2015, slightly higher than in 2014 and significantly higher than historical levels, the report says. In fact, more than half of the total spending growth in 2015 was from drug brands that have been available for less than 24 months.

Changes in how insurers cover prescription drugs also are putting increased pressure on consumers, the report notes. A patient's "cost exposure" for a brand prescription filled through a commercial plan has risen by more than 25 percent since 2010, a trend IMS attributes to an increase in health plans with pharmacy deductibles, co-payments and co-insurance.

An increase in insurance coverage tied to Medicaid expansion and the Affordable Care Act exchanges, meanwhile, has been the leading driver of prescription growth in the past two years, while there has been a decrease in prescriptions filled by patients with other commercial insurance. ACA plan members spend more on drugs than those in non-exchange private plans, a previous report found, as many have unmet healthcare needs.

To learn more:
- read the report (registration required)

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