Number of drug 'super spenders' rises 63% in 2 years, says Prime Therapeutics

The number of drug “super spenders” is growing rapidly, a new study from Prime Therapeutics shows. 

The pharmacy benefit manager (PBM), which is owned by 14 Blues plans, analyzed data on 17 million members who had at least one month of eligibility for drug benefits in 2016, 2017 and 2018.

In 2016, 2,994 members were categorized as “super spenders,” meaning their pharmacy and medical drug therapy claims totaled $250,000 or more.

By 2018, that number had increased by 63% to 4,869, Prime Therapeutics found. This increase led to an additional $800 million in drug costs, according to the study.

In addition, the number of members whose costs were over $750,000 increased by 38% over that time frame, and the drug costs for those members increased to $417 million by 2018.

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“With continued growth in treatments for rare diseases, including one-time treatments that may carry million-dollar price tags, it’s very likely that healthcare cost will become even more skewed, with a smaller and smaller fraction of insured members accounting for a larger and larger portion of the total healthcare cost,” said Jonathan Gavras, M.D., senior vice president and chief medical officer at Prime, in a statement. 

“We must work to ensure drug and gene therapies are priced appropriately to the value they provide, obtained and billed via the cost-effective channel with the highest quality patient management, and value-based contracts are in place to recoup costs if the drug or gene therapy does not maintain effectiveness,” Gavras said. 

Prime Therapeutics noted in its analysis that the number of specialty drugs has been on the rise quite rapidly over the past few years, and they now make up 50% of total drug spend. Fifty-nine drugs were approved in 2018, and 34 of those were for rare diseases, the PBM said. 

RELATED: UnitedHealth study—Administering specialty drugs outside hospitals could save $4B 

Nearly half (48%) of the increase Prime found was attributable to cancer categories including breast, lung, kidney and colorectal cancers, non-Hodgkin lymphoma, melanoma and multiple myeloma. Drugs for those diseases accounted for $378 million of the additional cost.

Inherited, single-gene disorders also accounted for a significant part of the increase: $243 million, or 31%. The largest increases were attributed to hemophilia A and B, cystic fibrosis, spinal muscular atrophy, congenital hypophosphatasia, hereditary angioedema, cystinosis and Duchenne muscular dystrophy.

Based on the findings, the researchers estimate that these members will account for $4 billion in drug costs over the next five years.