Prescription Drug Cost Trends
The Centers for Medicare & Medicaid Services (CMS) estimates that prescription drug spending was approximately 9.4 percent ($263.3 billion) of all health care spending in 2012, growing only 0.4 percent from 2011... it projects sustained increases in drug spending from 2015-2022 of six percent or more annually as both drug prices and utilization increase.
The Prescription Drug Market
...increased FDA approvals for specialty drugs, near-monopoly pricing, and the growing need for effective treatments—experts project that “spending on specialty drugs is expected to skyrocket over the next decade and beyond” and “intensifying the cost and access trade-offs that payers and purchasers already face.”
Health Plan Efforts to Manage Specialty Drug Spending While Assuring Access to High Quality Care
- Integration of Pharmacy and Medical Benefits
- Policies to Maximize Treatment Adherence
- Growing Role of Specialty Pharmacies
- Utilization and Pharmacy Management.
Policy Options to Promote High-Quality, Cost-Effective Drug Coverage
- Encouraging alternative payments and
incentive structures—such as coverage with
evidence development—for new drugs and
- Shortening the exclusivity period for
generic biologics—to promote greater price
competition and earlier access to lower-cost
specialty drugs or bio-similars.
- Remove barriers at the state level that
restrict the use of biosimilars.
- View full report to see more policy options.