Stats, surprises and secrets revealed in annual drug-spending report

For a quick jolt, take a look at the top-line figures in Express Scripts' ($ESRX) annual report on drug spending. An increase of 13% in payer spending on meds last year? That's the first increase in several years, and the biggest in a decade. But dig down below that top layer, and you'll find other juicy stats, some surprising, some not so much. For the educated eye, the Express Scripts report offers numbers to back up a variety of trends--and news stories--that hit the pharma business in 2014.

Market-share grabbers. Some newer meds--besides the hep C drugs--have stolen share from their older rivals. Biogen Idec's ($BIIB) multiple sclerosis drug Tecfidera, approved in 2013, now ranks second in that market, with a share of about 18%. It's now the 5th biggest specialty med, spending-wise. Pfizer's ($PFE) Xeljanz, for rheumatoid arthritis, has doubled its share of the anti-inflammatory market in commercial plans, and made solid gains among Medicare patients, too, the report says. Newer HIV meds such as Stribild, from Gilead Sciences ($GILD), and Tivicay, from ViiV Healthcare, grabbed significant share in the Medicaid market, despite their higher price tags.

Competitive markets. The drama in the basal insulin market and respiratory meds can be painted by numbers in the Express Scripts report. Novo Nordisk's ($NVO) Levemir and Eli Lilly's ($LLY) Humalog--both also-rans in a market dominated by Sanofi's Lantus--enjoyed big leaps in utilization last year. Levemir use jumped by 60.5% in Medicare patients, while Humalog's utilization jumped by 57% in the commercial market and 19% in Medicaid. But Lantus held onto its slots in the Top 10--in commercial patients, as well as Medicare and Medicaid--partly because of price increases of about one-third.

Meanwhile, in the respiratory world, AstraZeneca's ($AZN) Symbicort saw utilization grow by almost 43% among Medicaid patients, while GlaxoSmithKline's ($GSK) Advair declined 34% in the same group and 11% in Medicare. And Symbicort broke into the top 5 asthma meds by market share, with Advair nowhere to be found on the same list.

Most successful new generic. That crown goes to the only copycat drug to make the top 10 overall: duloxetine, otherwise known as Cymbalta. The knockoff versions of Eli Lilly's blockbuster antidepressant rocketed ahead of its head-to-head rivals--and a host of other drug types, too--during the first full year after Cymbalta's exclusive lock on the U.S. market expired.

Big price increases. Lilly's big growth in utilization for Humalog happened despite a unit-price increase of 36%, bigger than any other drug in the top 10 traditional meds. Second place for price hikes in that group? Sanofi's ($SNY) Lantus, one of Humalog's head-to-head rivals, at 34%.

For specialty drugs, the unit-cost-increase winner was Biogen's MS drug Tecfidera, with a 22% increase; Novartis' ($NVS) cancer treatment Gleevec came next with a 17.6% cost increase. AbbVie's Humira managed big unit-cost growth in Medicaid and Medicare, but in both cases fell far behind Sanofi's cost boost for Lantus.

Biggest volume growth. That would be Lilly's Humalog in traditional meds and Biogen's Tecfidera on the specialty side, among commercial plans at least. Johnson & Johnson's ($JNJ) prostate cancer drug Zytiga was the fastest-growing among Medicare's top 10 specialty drugs. Novo's Levemir took the same title among Medicare's traditional meds. Medicaid? Biogen's Tecfidera and AstraZeneca's Symbicort.

Biggest, period. These are no surprise, because they're the biggest sellers in the world overall. AbbVie's ($ABBV) Humira tops the specialty meds category, while AstraZeneca's Nexium comes in first on the traditional meds side. In Medicare and Medicaid, the top specialty med was Gilead's Sovaldi, while Lantus leads the traditional field in Medicare and Bristol-Myers Squibb's ($BMY) antipsychotic Abilify takes first place in Medicaid.

Hepatitis C is its own case. For all of the above, we left the new hepatitis C drugs out of the calculation, because in unit-cost growth and utilization, they take every cake. The percentage increases are difficult to grasp--14,666% for J&J's Olysio, for instance--and more difficult to swallow, because the basis for those calculations is so incredibly low. After all, Olysio and J&J were approved in late 2013, so their sales were necessarily low for that year. Suffice it to say that the hep C drugs from Gilead (Sovaldi, Harvoni) and J&J (Olysio) all rocketed into the top 10 among specialty meds, with big-time spending for all. Sovaldi by itself accounted for $24.38 in spending per member per year in the commercial market.

- check out the Express Scripts report (PDF)
- listen to the newest FierceBiotech Radio episode with Express Scripts CMO Steve Miller

Special Reports: 10 big brands keep pumping out big bucks, with a little help from price hikes | The top 10 most expensive drugs of 2013