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Self-funded employers spend 40% of costs on less than 1% of prescriptions

Willis Towers Watson’s Rx Collaborative, the largest employer-based pharmacy benefit group purchasing coalition in the U.S., disclosed that specialty drugs accounted for less than 1% of all the coalition’s prescriptions last year, yet totaled 40% of its total drug costs. In addition, the top 10 drugs by gross cost accounted for 20% of employers’ pharmacy spend in 2018.

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Source: Specialty Pharmacy Times

“Pharmacy represents about 20% of employers’ overall health care spend and is expected to reach 25% by 2020. This cost pressure has many employers turning to a drug purchasing collaborative to help control costs and improve pharmacy benefit performance,” said Nadina Rosier, Pharm.D., head of the Pharmacy practice at Willis Towers Watson.

“The successful formula for employers’ prescription drug plans centers on joint purchasing power, tools to manage specialty pharmacy costs, and innovative medical and pharmacy benefit strategies that improve employees’ health.”

Which prescription drugs make this esteemed list? Here’s a quick rundown of the five medicines expected to become the industry’s biggest earners in the next decade. These 5 Prescription Drugs Will Generate a Jaw-Dropping $62.3 Billion in 2024. 

The Top Five

  1. Merck’s cancer-fighting immunotherapy Keytruda tops this list, with a projected revenue haul of $17 billion by the end of 2024. Merck’s Keytruda is also the drug with fastest pace of sales growth on this list, thanks to its ability to grab several key new indications over the prior two years. 
  2. AbbVie’s flagship anti-inflammatory medicine Humira is predicted to slip to second place on this list, with an estimated 2024 revenue forecast of $12.4 billion. In 2018, this drug blew away the rest of the field with a gobsmacking $19.9 billion in global sales. 
  3. Bristol-Myers Squibb and Pfizer’s next-generation blood-thinner, Eliquis, is a close third, with 2024 sales expected to hit a monstrous $12 billion. Bristol and Pfizer raked in a whopping $6.4 billion from Eliquis in 2018.
  4. Bristol’s PD-1 inhibitor, Opdivo, a rival to Merck’s Keytruda, is slated to generate a healthy $11.3 billion by 2024. Once upon a time, Bristol’s Opdivo was widely predicted to top this list, but a major miss in advanced lung cancer opened the door for Merck’s Keytruda to become the undisputed champion of the PD-1 inhibitor space. 
  5. AbbVie and Johnson & Johnson’s game-changing blood cancer drug Imbruvica is set to occupy fifth place, with an estimated revenue haul of $9.5 billion. Now, AbbVie and J&J’s Imbruvica might ultimately slip out of the top five. There are several new drugs gunning for Imbruvica’s most lucrative indications, and Pfizer’s breast cancer drug Ibrance should also bring home no less than $9 billion in annual sales by 2024.  
Tyrone’s Commentary:
Does it make sense to have the same entity manage and approve specialty Rx claims when that entity stands to benefit when these claims are approved? The short answer is heck no! The PA process can be an exercise in complete futility. Additionally, software, like CoverMyMeds, which is supposed to streamline the PA process is far to often a rubber stamp exercise so that the PBMs who own specialty pharmacies can speed time to money. If you’re interested take a look at who owns CoverMyMeds. Employers who are serious about bending the specialty Rx cost trend are seeking alternative methods to reduce cost and improve outcomes. One such alternative is individualized care planning.

Tyrone Squires, MBA, CPBS

I am the proud founder and managing director of TransparentRx, a fiduciary-model PBM based in Las Vegas, Nevada. We help health plan sponsors reduce pharmacy spend, by as much as 50%, without cutting benefits or shifting costs to employees.

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