Ranks of 'super-spender' patients triple, pushing drug bills up $52B

A small but growing group of patients is racking up big drug bills in the U.S. On a per-patient basis, it's staggering: Some 576,000 Americans generated more than $50,000 in prescription drug costs each last year, according to a report from Express Scripts ($ESRX). And nearly 140,000 of them totted up drug bills of $100,000 or more.

On a national basis, it's even more staggering. These "super spenders" added up to a $52 billion drug bill for payers, the pharmacy benefits manager says.

The year-over-year increase? Shocking, at 63% for the number of patients with $50,000-and-up drug costs. And the number of patients with $100,000-and-up bills? Tripled last year, compared with 2013.

It's not as if these bills are a matter of choice, of course. More than a third of the top-spending patients were treated for 10 or more different medical conditions. About 60% took 10 or more different drugs. And unsurprisingly, almost the same share were older folks, aged 51 to 70 years.

Also unsurprisingly, most of them counted pricey specialty meds among their treatments. Nine out of 10 of the $50,000-and-up patients, in fact.

Two diseases drove a big share of those costs: Cancer, which accounted for nearly two-thirds of the costs for the $100,000 tier. And hep C, where the number of patients taking meds expanded more than sevenfold.

The good news for patients in all this is that they paid a small fraction of the total expense. Good thing, too, because as Express Scripts points out, $50,000 is higher than the median family income in the U.S. Insurance plans and employers covered more than 98% of the costs for patients whose bills topped $100,000, paying almost $157,000 per patient, on average. Those patients themselves paid about $2,800, the report states.

Express Scripts has a few ideas for addressing these fast-rising costs--including the hardball negotiations it's been undertaking with drugmakers. The PBM triggered a price war in hepatitis C with its cut-rate exclusive deal for AbbVie's ($ABBV) new Viekira Pak treatment. Now, it's gearing up for battle with makers of some forthcoming cholesterol meds, PCSK9 inhibitors, expected to be quite costly. And cancer drug costs are also in its sights, although that fight is likely to be much more complicated--and longer-lasting--than its dickering over hepatitis C.

But cost control doesn't stop there. Fortunately for pharma, one of Express Scripts' other targets is compounded drugs, which were the third-largest contributor to these patients' high drug costs. Usage is up by about a third, while prices have quadrupled--and that's often "wasteful spending," Express Scripts figures, that adds "little value" to patient outcomes.

Another is a common concern: adherence. Both Express Scripts and drugmakers would like for patients to take their meds as directed. Outcomes are better, of course, particularly for patients with cancer and diabetes, and proper use of meds can prevent costly complications.

- read the Express Scripts blog post

Special Reports: The 25 most influential people in biopharma in 2015 - Steve Miller, Express Scripts | 10 big brands keep pumping out big bucks, with a little help from price hikes

Suggested Articles

Belén Garijo, currently CEO of Merck Healthcare, will succeed Stefan Oschmann as the German company's chief exec when his tenure ends in April 2021.

More than 60 researchers and bioethicists called on Pfizer to take time to collect more COVID-19 vaccine safety data, Bloomberg reports. 

Leaked details about an ad campaign to quell coronavirus fears before the election raise "every red flag I could dream of," an ex-HHS official said.