As more competition makes its way into the specialty drug market, there will be opportunities for cost savings for orphan conditions, cancer types, and even common specialty conditions, explained Aimee Tharaldson, PharmD, senior clinical consultant for emerging therapeutics at Express Scripts, who presented on the specialty pharmaceutical pipeline during her regular session at AMCP Nexus 2019.
There is a $34 billion market opportunity for first-time generics for specialty medications over the next 4 years as several specialty drugs go generic, she explained. There is expected to be generics for the multiple sclerosis drug Tecfidera, which has annual sales of about $3.5 million, beginning in September 2020. At the same time, the market will see first-time generics to Truvada, the pre-exposure prophylaxis for HIV, which has annual sales of about $3 billion.
Based on Express Scripts’ data, 45% of per-member per-year (PMPY) spend in the pharmacy benefit is for specialty medications. The specialty trend is higher than the traditional trend (+9.4% vs –5.8%), and by 2020 about half of all spend in the pharmacy benefit will be for pharmacy medications, Tharaldson said. And yet, less than 2% of patients take specialty drugs.
The leading specialty therapy classes are inflammatory conditions, which cost $174 PMPY and include Humira, Stelara, and Enbrel. The second most expensive specialty therapy class is cancer, which costs $80 PMPY; followed by multiple sclerosis (MS), which costs $56 PMPY; and HIV, costing $49 PMPY.
There were 17 novel cancer drug approvals in 2018, but only eight in 2019, which represented a big drop. Each year, there are 1.7 million new cases of cancer diagnosed and since 1991, the death rate has dropped 25%.