The latest insights on specialty drug spend and trend across pharmacy and medical benefits
The sixth annual State of Specialty Spend and Trend Report analyzes specialty drug utilization and spending across 73.9 million medical claims and 55.1 million pharmacy claims. Our Artemetrx® platform integrates pharmacy and medical claims data to the individual patient level, enabling us to present a complete and unique view of specialty costs across all benefits.
Key Takeaways
Here’s a sneak peek into a few of the key findings
- Inflammatory conditions remain the top category and Humira the top drug in terms of overall plan cost. As biosimilars and specialty generics enter the market in 2023, this could shift.
- The percentage of specialty spend in the medical versus pharmacy benefit is 64.5% pharmacy / 35.5% medical – reflecting a return to 2016 percentages.
- Specialty drug plan cost continues to grow rapidly, reaching $1,295 per member per year (PMPY) – double the cost compared to 2016.
- After a reduced trend of 11.8% from 2019-2020, likely pandemic-related, specialty trend from 2020-2021 rebounded to 14.2%.
- Stabilizing at 4.8% for 2019 and 2020, the percentage of the population utilizing at least one specialty drug increased to 5.9% in 2021.
