2020 Drug Trend Report

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Rising to challenges
and elevating health.

In a year like no other.

2020 Drug Trend Report Hero Animation

Listen as Dr. Stettin highlights what you can expect to discover in the 2020 Drug Trend Report

Dr. Stettin
Audio file

This is your opportunity to explore the latest trends in usage and costs for the medications that Americans took to get and stay healthy during a year like no other.

Hi and welcome to the 2020 Drug Trend Report, presented by Evernorth.

I’m Dr. Glen Stettin, Chief Innovation Officer. This year, we continue our nearly 25-year legacy of publishing an annual Drug Trend Report, first as Express Scripts, and now as Evernorth.

This is your opportunity to explore the latest trends in usage and costs for the medications that Americans took to get and stay healthy during a year like no other.

The report will enable you to:

  • Explore the effects of COVID-19 on drug usage and adherence in critical treatment categories
  • Examine the pandemic’s effect on America’s mental health
  • Understand how the most progressively managed plans achieved better care and higher savings
  • Consider the benefits of digital health and meeting members where they are
  • And gain our perspective on what’s ahead for the rest of 2021 and beyond

Be sure to download the 2020 Executive Summary for key analyses and insights at a glance.

We look forward to our work together to advance health care.

In the meantime, stay healthy.

Glen Stettin, MD
Chief Innovation Officer

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Download Executive Summary
Get a two-page summary of the key findings from this year’s report.
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Navigating COVID-19

The pandemic made a direct impact on specific drugs, classes and even the flu vaccine. It led to better adherence in critical categories and increased use of medications to treat mental health conditions.


Delivering for Patients

Through clinical solutions, including digital health, and support from Express Scripts® Pharmacy and specialized pharmacists, patients were able to improve adherence to the medications they needed to stay healthy, despite the COVID-19 crisis.


By the Numbers

Take a closer look at the data and insights from the past year, covering utilization and unit costs for prescription drugs, including brand and specialty medications.

Methodology FAQs

Get answers to frequently asked questions about the data we used to develop this report. 

We analyzed one of the broadest cohorts in the industry—more than 33 million Americans with a funded pharmacy benefit plan administered by Express Scripts.6

6  Plan sponsors were excluded if they were not Express Scripts clients in both 2019 and 2020; or if they had less than 12 months of claims data in either year, 100% or 0% copayment benefits, or large shifts in eligibility.

We included prescribed medications covered for patients outside of the hospital setting, prescribed acutely or for ongoing use, and paid almost exclusively under plans’ pharmacy benefit programs. This includes many specialty drugs, which serve more limited patient populations and may require special access or support due to one or more of the following situations: frequent dosing adjustments, intensive clinical monitoring, intensive patient training and compliance assistance, limited distribution, and specialized handling or administration.

Nonprescription medications (except for diabetic supplies billed under the pharmacy benefit), vaccines, prescriptions that were dispensed in hospitals, long-term care facilities, and other institutional settings, and medications billed under the medical benefit at any time in 2019 or 2020 were excluded.

Yes, but we calculate and report drug trend and other measures separately by type of benefit. For example, commercial (employment-based benefits), Medicare, managed Medicaid and individual and family plans (health exchange).

We calculated drug trend as the percentage change in total drug costs, per person, for 2020 vs. 2019. Total drug costs equal the total cost of the medication (ingredient costs, taxes, dispensing fee and administrative fees) paid per person by plans and plan members. These figures reflect all pharmacy and drug-specific discounts, including rebates, earned by the plans. These figures also include some, but not all, of the impact of member assistance and coupon programs, which are likely underestimated to a significant extent.

We break down drug trend for payers into two components—unit cost trend and utilization trend—per member, per year (PMPY), not including member contribution to cost. Unit cost trend is the rate of change in unit costs due to the combined impact of inflation, discounts and drug mix. Utilization trend is the rate of change in total days’ supply of medication dispensed across all prescriptions.

The Express Scripts Prescription Price Index (PPI) measures inflation in prescription drug prices by monitoring changes in list prices for a fixed market basket of commonly used prescription drugs. Separate market baskets, which were defined for brand drugs and for generic drugs, were based on the top 80% of utilized drugs, starting in 2016.

Since the first Express Scripts Drug Trend Report in 1997, we’ve continued to provide the trend data and insights payers need to provide high-quality care to their members and manage costs. Now, as Evernorth, we carry on the tradition and elevate the value we deliver. You can view and download previous reports and/or summaries for the past 10 years.