Specialty Exceeds Traditional in Drug Spend

Specialty drugs used to be the boutique part of the drug spend: expensive, yes, but unusual. Ten years ago, specialty accounted for 15% to 20% of the money spent on drugs, according to Prem Shah, executive vice president of specialty pharmacy and product innovation at CVS Health.

But the CVS Caremark 2020 Drug Trend Report shows that specialty drugs accounted for more than half (52%) of the pharmacy spend last year. The 2020 drug trend report from Evernorth (the new Cigna entity that Express Scripts is now part of) also showed that the spend on specialty drugs edged ahead of the spending on traditional medications (50.8% versus 49.2%).

Five therapeutic categories are driving 90% of the specialty trend for CVS Caremark. “Autoimmune is the largest drive because of supplemental indications, which is driving more utilization,” says Shah. The other four were oncology, cystic fibrosis, atopic dermatitis and HIV. Shah says new oncology products continue to be a large driver of spending and that in cystic fibrosis “you are starting to see patients take more drugs per patient.”

Evernorth’s report says 17 of the top 25 drugs ranked by total pharmacy spend were specialty medications in 2020.