Vizient Drug Report: Remdesivir Knocks Humira Off As Top Drug Spend

For years, AbbVie’s Humira (adalimumab) has been at the top of the table of provider drug expenditures.

But with COVID-19, there is a new drug that leads the pharma spend. The powerful anti-inflammatory agent that is used to treat many autoimmune conditions has been replaced by remdesivir, the COVID-19 antiviral (marketed by Gilead under the name Veklury) according to a new drug spend report from Vizient.

Vizient, a group purchasing organization that branched out into other services, says its clients include about half of the country’s acute care providers and nearly all (97%) the academic medical centers.

After remdesivir and Humira, the top drugs by expenditure among Vizient’s clients were Merck Keytruda (pembrolizumab), used to treat many different types of cancer; Janssen’s Stelara (ustekinumab), an autoimmune disease treatment drug like Humira, and Genentech’s Ocrevus (ocrelizumab), a treatment for relapsing or primary progressive multiple sclerosis.

Here is Vizient’s list of the top 10 drugs by total spend:

The report notes that all of the drugs in the top spend list are injectable medications, with most administered in an ambulatory setting such as infusion center or specialty center.

But it also lists the top 10 ten drugs for acute care by spend — a list, the report says, that reflects the drug spend by Vizient clients for inpatient care. Remdesivir, which until last week was FDA-authorized only for use in the hospital, still tops the list for the acute care drug spend from October 2020 through September 2021. Next on the list are Activase (alteplase) a clot-busting agent used to treat people having heart attack or strokes, and Endo’s Vasostrict (vasopressin), which constrict blood vessels and is used to treat septic shock and other conditions.

Here is Vizient’s list of the top acute care drugs by drug spend. The list on the right is the one more reflective of drugs used in the in-patient setting:

Biosimilars to Humira are expected to hit the market in 2023. The report says that when that happens it will “further disrupt the spend on Humira and overall spend in the nonacute market.” Before the pandemic, experts were eyeing next year as when the expenditures on Humira would fall when as many as six biosimilars are expected to come on the market.

“It was thought the Humira biosimilars would put an end to reign of Humira as a top spend drug; however no one could predict the enduring impact COVID-19 would have,” the report says.

The Vizient report, which came out yesterday, has some notable limitations. It ranks drugs by relative expenditure without giving information about how much money was spent or is expected to be spent. Also, Vizient’s clients are not necessarily representative of U.S. hospitals and other provider organization. Moreover, the company says it clients include more than 20% of ambulatory care providers, so its drug spend might not reflect of the spend for large majority of ambulatory care providers that are not Vizient clients.