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Fitzgerald Health Education Associates, Inc., May 2015 fhea.com
Use of Specialty Drugs Costing More
Than $50K Triples in a Year
A report by Express Scripts, the largest US pharmacy
benefit manager, found that nearly 600,000 US pa-
tients had medication costs over $50,000 in 2014—a
63% increase from 2013. In a statement, the compa-
ny noted that the estimated 575,000 patients who
used at least $50,000 in prescription medicines last
year were "overwhelmingly taking specialty medica-
tions, and have multiple (health problems), prescrip-
tions, and providers." Express Scripts defined special-
ty medications as expensive treatments for complex
conditions.
Costs were driven by hepatitis C, cancer, and com-
pounded treatments. Baby Boomers, ages 51 to 70,
surpassed other age-groups as the highest-cost
medication users, making up 58% of the population
with annual drug costs exceeding $100,000 (an in-
crease of 243% from 2013 to 2014). Among adults
aged 51 to 70 in the high-cost category, 77% were
being treated for hepatitis C and 50% were being
treated for cancer. New drugs for these diseases can
cost upwards of $90,000 per patient.
Approximately 139,000 of the 575,000 patients
used at least $100,000 worth of medications, nearly
triple the 47,000 who did so in 2013.
The total cost to the health plans for US patients
with prescription drug expenses over $50,000 was
$52 billion in 2014. Health insurance covered 97.4%
of the drug expenses among patients prescribed at
least $50,000 worth of medicines in 2014. The report
contrasted this figure with the finding that patients
with less than $1000 in total prescription medication
costs paid 35% of the bill out of pocket.
The report found that among patients whose
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Continued on page 19
Fitzgerald Health Education Associates, Inc.