Ten Takeaways from the Evernorth Drug Trend Report

Sharon Phares, PhD, MPH
April 21, 2021


Recently, Evernorth released their 2020 Drug Trend Report. For many years this report, recently rebranded from Express Scripts to Evernorth, has been one of the more informative drug trend reports in the industry. We applaud their continuing dedication to providing drug trend information to the marketplace and being transparent in its methods.



Ten takeaways from the report: 

  1. The COVID-19 pandemic had a significant impact in ways that may reverberate for years to come. A Kaiser Family Foundation poll in May 2020 found that more than 50 percent of people reporting delayed medical treatment. This insight was evident in the Drug Trend Report because the number of people initiating treatment for “silent” conditions such as high blood pressure, high cholesterol, diabetes, and cancer was down. Early diagnosis and appropriate treatment for these conditions can prevent disease progression and even death and help keep healthcare costs lower.
  2. COVID-19 also had an impact on mental health. The utilization of antidepressants increased 7.9 percent in 2020 versus 2019, and nearly one-third of antidepressant users were new to therapy.
  3. The commercial plan drug trend was 4.0 percent, driven primarily by utilization (3.1 percent). This is a higher trend than seen in the last few years.
  4. Drug unit costs remained stable with an increase of 0.9 percent. Brand drugs increased an average of 4.3 percent, but new generics entering the market, therapeutic mix, and managing the supply chain kept price increases low.
  5. Price increases for commonly used brand drugs were up 36 percent, but this was offset by a more than 42 percent decrease in commonly used generic drugs. The Express Scripts Prescription Price Index continues to demonstrate the value of generic drugs over time.
  6. However, average patient out-of-pocket costs were up more than 7 percent per 30-day prescription, more than five times the rate of 2020 inflation (1.25 percent). However, the absolute increase in dollars may seem small (an increase of $0.85 from $11.51 in 2019 to $12.36 in 2020). Analysis of PSG data found that patients with at least one prescription drug claim in 2020 had an average of 13 prescriptions filled, so the costs add up.
  7. For the first time in this report, the specialty drug trend surpassed 50 percent of overall pharmacy spend. The report forecasts specialty spend to increase 10 to 15 percent over the next few years, which is in line with the 11.6 percent specialty trend projected growth over the next three years by PSG’s State of Specialty Spend and Trend Report. The challenges of specialty drug cost and utilization do not look to be abating for plan sponsors in the next few years.
  8. Inflammatory conditions topped the list of highest trend again with an increase of 15.6 percent (4.5 percent utilization; 11.1 percent unit cost). Evernorth reported that specialty injectable medications account for nearly 95 percent of medication spend in this class.
  9. Cancer was second for the highest trend at 12.6 percent (5.8 percent utilization: 6.8 percent unit cost). Evernorth only reports drug costs and utilization under the pharmacy benefit; therefore, this does not include most infused cancer medications, which typically bill under the medical benefit.
  10. Despite opioid- and other drug-related overdose deaths soaring during the COVID pandemic, prescriptions for opioids fell by 10.3 percent in 2020. The trend in the pain and inflammation category, which includes opioids as well as other analgesics and other anti-inflammatory drugs like nonsteroidal anti-inflammatory drugs (NSAIDs), dropped 20.4 percent (1.3 percent utilization: 19.1 percent unit cost).


The drug pipeline is full of promising, potentially life-saving drugs, but plan sponsors have legitimate concerns about rising pharmacy benefit costs. Taking a proactive, actionable, data-driven drug management approach can help manage costs.

Sharon Phares, PhD, MPH, is the Senior Vice President of Research for PSG and an Assistant Adjunct Professor of Clinical Pediatrics and Assistant Adjunct Professor of Internal Medicine with Washington University in St. Louis. Prior to joining the PSG, Sharon was Vice President of Research and Analytics at Express Scripts where she led research strategy and execution for one of the largest PBMs in the nation. She has also held leadership roles in health and economic outcomes research, survey design, pilot and program design and evaluation, analytics and research consulting, advanced analytics, and the development of predictive models at Walgreens, LabCorp, and Landacorp. She was an instructor at North Carolina State University and provided evaluation research for various state and local government agencies before joining the private sector.