Which brands grab the drug-spending title? AbbVie's Humira, AZ's Nexium lead the way

Which drugs cost U.S. health plans the most? That's one question answered by this year's iteration of Express Scripts' annual Drug Trend Report. Take a look at the lists, and you'll find commentary on drug prices, the pharma industry, and American society. Not to mention a hint at which brands are best at getting themselves noticed.

First, some overall intel: Drug spending grew more than 5% last year, with specialty meds leading the charge. As a pharmacy benefits manager, Express Scripts ($ESRX) tracks spending on a per-member basis, and by that measure, spending on "traditional" meds amounted to $628 for each member, a 2.4% increase, while specialty spending rose 14% to $240.57.

Considering that specialty drugs accounted for just 1% of all U.S. prescriptions, Express Scripts notes, that's a hefty amount. And it's more than a quarter of total drug spending.

The brands that top per-member spending on specialty meds? No surprise that AbbVie's ($ABBV) anti-inflammatory blockbuster sits at the top of this list. For the moment, it's the world's best-selling drug--and paying for Humira prescriptions costs $28.33 per plan member.

Enbrel, another anti-inflammatory, came in second at $22.57 per member per year. But it was multiple sclerosis that dominated the top 10, with Teva Pharmaceutical Industries' ($TEVA) Copaxone in third place ($15.57), Biogen Idec's ($BIIB) Avonex in fourth ($8.89), Merck Serono's Rebif in eighth ($6.12) and Novartis' ($NVS) Gilenya in ninth ($4.82).

Two blood cancer drugs--Celgene's Revlimid and Novartis' Gleevec--also made an appearance in the top 10.

The anti-inflammatory class has been a big one for some time, with expensive treatments for a range of painful, difficult chronic illnesses such as rheumatoid arthritis and psoriasis. Revlimid and Gleevec are poster children for the new-and-improved treatment of blood cancers; thanks to effective drugs, patients are living years longer than they did with older treatments. Multiple sclerosis is destined to grow even more, with newly approved products taking hold in the market.

It's also worth noting that almost every drug in the top 10 cost more last year than in 2012. Rebif's cost per unit leaped by 19%, and Humira's increased by 15%.

As for traditional drugs, the brands are familiar. AstraZeneca ($AZN) took the top two slots, with its stomach-acid drug Nexium at $23.76 per member for the year and its cholesterol-fighting statin Crestor at $16.81. Eli Lilly's ($LLY) Cymbalta, an antidepressant, came in third at $13.54.

Spending on off-patent or soon-to-be-off-patent brands--including Nexium, Cymbalta and GlaxoSmithKline's ($GSK) asthma drug Advair--all grew not because they were used more, but because they cost more. Per unit, the cost of Cymbalta went up 19%. Nexium cost 13.4% more, offsetting a utilization decrease of almost 10%. That's no surprise; it's common for drugmakers to hike prices on drugs nearing the end of their market monopolies.

Diabetes drugs took three spots in the top 10: Sanofi's ($SNY) Lantus in fourth place ($13.54), Eli Lilly's Humalog in eighth ($7.55) and Januvia in ninth ($7.23). Costs for all of them were up significantly. More people used Lantus and Humalog in 2013, too; considering the diabetes epidemic in the U.S., that makes sense. Januvia usage didn't grow, perhaps because of side-effect worries that afflicted its drug class. The anxiety eased up only when the FDA said its safety review found no compelling evidence that the drugs cause pancreatitis or pancreatic cancer.

Meanwhile, the only generic drug used often enough to make the top 10 was amphetamine/dextroamphetamine--otherwise known as ADHD treatments. Use of these drugs ballooned by 12.2% last year, the only double-digit increase on the list. It was also the only drug whose cost per unit dropped (by 8.2%). Net? Spending still grew by 4%, to $8.36 per member per year. This one line item demonstrates the cost of the wave of ADHD diagnoses that's attracted so much attention--and inspired so much hand-wringing--in recent years.

Speaking of hand-wringing, we'll leave you with a worrisome prediction. It's one that Express Scripts and a host of others have been warning about for months: The ballooning cost of treating hepatitis C. Thanks to some breakthrough new treatments, Express Scripts predicts spending on hep C drugs will increase 1,800% between 2014 and 2016. "No major therapy class has experienced this high of a rate increase in the 21 years Express Scripts has recorded drug trend data," the trend report states.

That's one big reason why specialty spending is forecast to leap by 63% over the same three-year period. And a big reason why Express Scripts is leading a charge against the first of the new generation, Gilead Sciences' ($GILD) Sovaldi, hoping to push prices downward. The current list price of Sovaldi is $84,000 per treatment course.

- check out the trend report

Special Reports: The 10 best-selling drugs of 2013 - Humira - Enbrel - Advair - Lantus - Crestor