Blue Cross Blue Shield Association Examines the Growing Costs of Specialty Pharmacy

May 24, 2016

CHICAGO – A new study by the Blue Cross Blue Shield Association (BCBSA) and HealthCore, Inc. shows that per-member specialty pharmacy spending increased 26 percent from 2013 to 2014.

The report, “The Growth in Specialty Drug Spending from 2013 to 2014,” represents a comprehensive, in-depth study of costs for both medical and pharmacy claims. Approximately half of specialty drug spending is funded by each benefit.

Examining medical benefit data allows for a thorough analysis of changes in the cost of medication administered at hospitals and other clinical settings. For example, more than 80 percent of cancer medication costs is billed through the medical benefit. Comparing specialty pharmacy spending in 2013 and 2014, this study found that:

  • There was an $87 annual per-member increase in specialty pharmacy spending from 2013 to 2014.
  • The increasing costs of specialty drug treatments were the main driver of the growth in spending. Treatment costs include the price and selection of drugs. Increased utilization had
    a smaller effect on the growth in spending.
  • In 2014, annual specialty drug spending was 17 percent higher per member in the individual market compared to the employer market. While cost of treatment was similar between employer-based and individual members, there were differences in utilization rates by condition. Utilization was significantly higher for individual members for cancer, human immunodeficiency virus and hepatitis, but slightly lower for inflammatory conditions (such as rheumatoid arthritis) or multiple sclerosis.

Total cost of treatment increased across all specialty drug categories featured in the study. Of the 26 percent cost increase for specialty drugs between 2013 and 2014 for commercially insured members, 15 percent can be attributed to higher costs for treatments. Utilization accounted for an 11 percent increase in specialty pharmacy spending.

“The recent, rapid increases in specialty drug costs are a concern for everyone—the public, medical professionals, healthcare companies, employers of all sizes, taxpayers who bear the cost of prescription drugs provided by government programs such as Medicare and Medicaid, and those who receive financial assistance to purchase individual coverage,” said Dr. Trent Haywood, chief medical officer for BCBSA.

“To promote affordability and access to new innovative medicines, it’s important to have greater competition and choice to bring costs down for everyone, including speeding up the approval of generic and biosimilar drugs,” Haywood said. “There also should be transparency regarding the pricing of prescription medicines with information about price and a drug’s effectiveness made widely available to the public.”

For Blue Cross and Blue Shield of Louisiana, specialty drugs dispensed through the pharmacy benefit make up only one percent of the drugs, yet 40 percent of the cost.

“For people with serious medical conditions, ground-breaking specialty drugs provide tremendous benefit,” says Milam Ford, vice president of Pharmacy Services at Blue Cross and Blue Shield of Louisiana. “This makes addressing the cost issue critical to assuring a sustainable healthcare system that is affordable for patients, businesses and taxpayers.”

This is the seventh study of The Health of America ReportSM series, a collaboration between the Blue Cross Blue Shield Association and Blue Health Intelligence, which uses a market-leading claims database to uncover key trends and insights into healthcare affordability and access to care. This report was written by and also includes medical claims data from HealthCore, Inc., a wholly owned and independently operated health outcomes subsidiary of Anthem, Inc.

For more information, visit www.bcbs.com/healthofamerica.

* The report covers the majority of Blue Cross and Blue Shield (BCBS) companies’ commercially insured and individual members across the country and approximately 70 percent of all BCBS membership, or a sample size of approximately 70.5 million BCBS members per year in 2013 and 2014. It does not include members who receive coverage through Medicare or Medicaid programs. All costs reported are the combined cost of payment by BCBS companies and by members (out of pocket). Costs do not account for rebates provided by drug manufacturers.

About Blue Cross Blue Shield Association
Blue Cross Blue Shield Association is a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for nearly 105 million members – one in three Americans. For more information on the Blue Cross Blue Shield Association and its member companies, please visit www.BCBS.com. We encourage you to connect with us on Facebook, check out our videos on YouTube, follow us on Twitter and check out The BCBS Blog for up-to-date information about BCBSA.

About BHI
Health Intelligence Company is the nation’s premier health intelligence resource, delivering data-driven insights about healthcare trends and best practices, resulting in healthier lives and more affordable access to safe and effective care. HIC accesses healthcare claims data from more than 140 million individuals nationwide, collected over nine years, in a safe, HIPAA compliant and secure database. The resulting conformed, reliable data set has the broadest, deepest pool of integrated medical and pharmacy claims, reflecting medical utilization in every ZIP code. Health Intelligence Company, LLC operates under the trade name Blue Health Intelligence (BHI) and is an Independent Licensee of BCBSA. For more information, visit http://www.bluehealthintelligence.com/.

About HealthCore, Inc.
HealthCore, Inc is a wholly-owned and independently operated subsidiary of Anthem, Inc., with a first of a kind large, integrated database and deep understanding of the complexities and nuances of big data. HealthCore helps clients achieve evidence-based competitive advantages through our innovative problem solving, analytics and outcomes research expertise. HealthCore doesn’t sell data. Instead, we design custom data-driven research solutions and guide our clients in the optimal use and interpretation of the data by evaluating the impact of disease, treatment and medical care on outcomes. HealthCore is headquartered in Wilmington, DE with additional offices in Andover, MA and Alexandria, VA. Our team includes scientists, biostatisticians, epidemiologists, pharmacists, and physicians. We are organized into three separate divisions, based on health care sectors, with firewalled teams collaborating with clients.

About Blue Cross and Blue Shield of Louisiana
Founded in New Orleans in 1934, Blue Cross and Blue Shield of Louisiana is a tax-paying nonprofit health insurer. We are a private company, mutually owned by our policyholders, with an independent Louisiana Board of Directors and no shareholders. We are an independent licensee of the Blue Cross and Blue Shield Association.

Blue Cross and Blue Shield of Louisiana is committed to improving the health and lives of all Louisianians. With our subsidiaries, HMO Louisiana and Southern National Life, we provide group and individual health insurance plans, life and disability insurance, group voluntary products and administrative services to one out of four Louisiana residents. We’re the only Louisiana insurer that offers plans in every parish. We also provide every customer with comprehensive wellness education, programs and services to help them live healthier lives. Headquartered in Baton Rouge, we have eight regional offices to serve our customers around the state.

Blue Cross and Blue Shield of Louisiana is dedicated to transforming the healthcare industry in Louisiana into one that delivers high-quality health outcomes for our customers with top-notch service at more affordable costs. Our reputation for exceptional service and prompt payments, as well as the hard work of our 200+ in-house doctors, nurses, pharmacists, social workers and dietitians, keeps both customer and provider satisfaction high. Surveys by the Louisiana State Medical Society and the Louisiana Hospital Association consistently rank Blue Cross the best company providers do business with.

Blue Cross is deeply committed to the communities we serve. We invest both time and money in the health and wellbeing of Louisiana children by supporting more than 200 charitable organizations. We invite and encourage all Louisianians to visit our website or talk to us on social media through our online hub.