New Trends of Hospital Pharmacy Expenditure: Specialty and Neurology Medications are Escalating

According to the report data released in the 2023 Summer Pharmacy Market Outlook by Vizient, Inc., hospital pharmaceutical spending is projected to increase by 3.42% in early 2024. This growth is primarily driven by specialty pharmaceuticals and drugs in the neurology service line. The report also reveals a continuous decline in demand for remdesivir, which has dropped from its previous position as a top drug in Vizient member spending during the peak of the COVID-19 pandemic and is now fallen into ranked 13th.

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Specialty Drugs Driving Pharmaceutical Expenditure Growth

Specialty drugs, used to treat high-cost, complex, or chronic conditions such as cancer, infectious diseases, autoimmune disorders, and pulmonary conditions, have led to an expansion in available treatment options. Three of the top five medications in Vizient member spending are classified as specialty drugs, including adalimumab (Humira), ustekinumab (Stelara), and denosumab (Prolia, Xgeva). Furthermore, two specialty oncology medications approved last year, Teclistimab (Tecvayli) and tebentafusp (Kimmtrak), have already made it into the top 100 drugs in Vizient member spending. The former is used to treat adult patients with relapsed or refractory multiple myeloma, while the latter is the only FDA-approved drug for unresectable or metastatic uveal melanoma.

Observations on Neurology Service Line and Biosimilars

The neurology service line has experienced new drug development and price increases, leading to higher utilization and costs for healthcare providers. Ocrelizumab (Ocrevus), used in the treatment of multiple sclerosis, was a significant part of Vizient member spending and is projected to have the highest price increase as the seventh-ranked drug. However, in December, the FDA approved ublituximab (Briumvi), a lower-cost monoclonal antibody for treating relapsing forms of multiple sclerosis, potentially reducing costs for healthcare organizations.
On the other hand, the calcitonin gene-related peptide class (CGRP) for migraine treatment has seen an increase in both treatment options and spending over the past few years. The annual treatment cost of monoclonal antibody CGRP therapy is around $6,900, with a 73% increase in Vizient member spending from April 2021 to March 2022, indicating wider utilization.

Decline in Remdesivir Spending Among Members

Since its peak in the 2022 January Pharmacy Market Outlook, where it held the top position, remdesivir, used to treat COVID-19, has seen a decline of 65% in total Vizient member spending. Despite retaining its overall ranking as the top drug in the acute care segment of the market, the decline in remdesivir spending is attributed to fewer adults and pediatric patients being treated for COVID-19 across the country, resulting in nearly $1 billion reduction in healthcare system spending.

Biosimilars Watch

The introduction of adalimumab biosimilars in January marked the end of a 20-year competition-free period for Humira, the top drug in Vizient member spending. Currently, there are two approved biosimilars on the market, with eight more expected to launch by the end of summer. These biosimilars are anticipated to be widely integrated into hospital pharmacy formularies within six to twelve months following their introduction. In the field of oncology, three biosimilar monoclonal antibodies launched in 2019, including bevacizumab (Avastin), trastuzumab (Herceptin), and rituximab (Rituxan), have experienced significant uptake in the market.

According to the outlook, biosimilars account for nearly 25% of total spending compared to their originator products. Currently, there are 40 approved biosimilars projected to save $181 billion over the next five years, spanning multiple service lines, according to the Center for Biosimilars. The projections in the Vizient Pharmacy Market Outlook are based on the top 85% of Vizient Pharmacy Program participants’ aggregated purchasing volume.

Key Trends of Drugs Expenditure Recent Years

In 2021, total healthcare pharmaceutical expenditures in the United States amounted to $603 billion, with retail drugs accounting for $421 billion. The increase in expenditures was primarily driven by a rise in prescription spending, followed by an increase in drug utilization. Non-retail drug spending grew more than retail drug spending (25% versus 13%). From 2016 to 2021, mail-order (up 35%), clinics (up 45%), and home care (up 95%) became the primary avenues for obtaining medications, while independent pharmacies (down 5%), long-term care facilities (down 17%), and federal agencies (down 9%) saw decreases.

Expenditures on specialty drugs saw a rapid growth, reaching $301 billion in 2021, a 43% increase since 2016, accounting for 50%. The impact of COVID-19 on drug expenditures was minimal. The “Inflation Reduction Act” enabled negotiation of prices for certain drugs, and medical insurance added anti-inflation measures. In 2017, out of 132 branded prescription drugs, 49 were top sellers, with almost all of them experiencing price increases (median increase of 76% from 2012 to 2017).

In summary, a study on changes in hospital pharmaceutical spending reveals that pharmaceutical costs have been rapidly rising in recent years, with a higher proportion spent on specialty drugs. This trend has been associated with drug shortages and price hikes impacting healthcare operations.

Author

Oscar Wu

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