By the Numbers

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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.

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trend for commercial plans in 2020, including utilization and unit cost

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increase in unit costs for 4th year in a row—even as brand drug list prices rose 4.3%

We mitigated unit cost through improvements in manufacturer and pharmacy discounts, and by helping prescribers and patients shift from costly to affordable treatments.

Drug trend for commercial plans managed by Express Scripts, 2017-2020

Since January 2016, list prices for brand drugs have continued to climb while generic drug prices have fallen sharply

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Price for commonly used brand drugs

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Price for commonly used household goods

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Price for commonly used generic drugs

Express Scripts Prescription Price Index, 2016-2020

Trend pressure

+ Inflammatory conditions

These are drugs used to treat rheumatoid arthritis, psoriasis and other autoimmune conditions. Specialty injectable medications account for nearly 95% of medication spend for this class.  


Average cost per prescription for specialty drugs in this class

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+ Cancer

Includes oral drugs to treat multiple myeloma, lymphoma, and breast and lung cancers. Brand-only oral drugs drove 30.5% of drug spend in this class.

Nearly 40

new cancer drugs approved in 2019 and 2020. Many are firsts for their indication with unique and novel mechanisms of action and treat rare cancers with relatively small patient populations.

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Reflects higher utilization and unit cost for drugs to treat HIV. Positive utilization trend reflects an increase in the percent of patients using HIV medications (3.7% over 2019). Generic availability for pre-exposure prophylaxis (PrEP) placed downward pressure on unit cost trend.

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Trend relief

+ Pain and inflammation

Opioid utilization fell by 10.3% in 2020, following a 15.2% decline in 2019.

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+ Antihypertensives

Generic medications, which comprised 98.7% of the market in 2020, had a 5.3% decrease in unit costs exerting downward pressure on overall trend. But with 17 out 100 people taking an antihypertensive medication in 2020, these drugs still accounted for 2.1% of total spend.

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Percent of total drug spend, traditional and specialty drugs paid under the pharmacy benefit, 2020

50.8% of drug spend is specialty medications and 49.2% is traditional medications

For the first time ever, more than half of pharmacy spend was on specialty drugs

While drugs to treat rare and specialty conditions were used by less than 2% of the population in 2020, they accounted for almost 51% of spending under the pharmacy benefit.

17 of top 25 drugs

ranked by total pharmacy spend were specialty medications in 2020

Patient share of pharmacy costs increased slightly in 2020

Their share went from 14.3% in 2019 to 14.9% in 2020. Patients paid an average of $12.36 for a 30-day supply of prescription medication in 2020, an increase of 85¢ vs. 2019.

Cost sharing between patients and plans, 2020