Specialty drugs now account for more than half of pharmacy spend, a new report from CVS Health shows.
CVS Caremark released its annual Drug Trend Report, which found that specialty medications accounted for 52% of drug spend in 2020. The pharmacy benefit manager also found a 98% increase in utilization related to conditions with new therapies or indications on the market.
Five therapeutic categories drive 90% of specialty spend, CVS said.
Sree Chaguturu, M.D., chief medical officer at CVS Caremark, told Fierce Healthcare there are a number of key strategies that can assist in mitigating these rising costs. One is "starting patients with certainty" and ensuring they're taking the appropriate products.
In addition, there are plenty of opportunities to address waste in specialty pharmacy. Draw up accumulation, dose escalation and costly adverse events all represent areas where wasteful spending can accumulate.
"We really think it’s important to eliminate waste in specialty spend," he said.
For example, when a patient experiences an adverse event, harnessing technology to close the loop between the patient and provider can avoid unneeded spend and speed up the care process, Chaguturu said.
Staying closely connected to the member can also allow pharmacy benefit managers to more quickly address supply challenges they may face, he said.
The report also found a significant drop in the number of people starting therapy, or adding new medications, for chronic conditions during the pandemic. In April 2020, at the height of shutdowns due to COVID-19, new initiations fell from just under 50 per 1,000 members to about 30 per 1,000 members among Medicare beneficiaries.
In commercial plans, the number fell from about 20 initiations per 1,000 members to just over 10 initiatives per 1,000. Caremark saw a similar decline among Medicaid members, according to the report.
Initiations did rise again in June and July as shutdowns eased, according to the report, though levels were still below pre-pandemic rates across Medicare, Medicaid and commercial coverage.
Chaguturu said CVS deployed enhanced mail services and expanded prior authorizations as a way to mitigate the declines. Caremark also did critical outreach to members to ensure they understood the need to continue their therapy for chronic conditions.
"It really helped to create continuity so that it didn't decline further," Chaguturu said.