The Drug Trend Report

Report Section

Drivers of Specialty and Non-Specialty Trend

Autoimmune Conditions Were the Greatest Contributor to Specialty Growth…

In 2021, specialty growth was largely driven by utilization increases of specialty treatments in certain categories, including autoimmune and asthma/atopic dermatitis. The increase in utilization was driven by new therapies and indications, as well as changes to guidelines for conditions like psoriasis and eczema that made more people eligible for treatment.

Autoimmune Treatments Accounted for More Than Half of All Specialty Utilization Trend

Chart titled “Autoimmune Treatments Accounted for More Than Half of All Specialty Utilization Trend” that shows the top drivers of specialty utilization trend as:

  • 54% Autoimmune
  • 36% Asthma/Atopic Dermatitis
  • 6% Oncology
  • 2% Infertility
  • 2$ Hormonal Therapies
Graph - Autoimmune Treatments Accounted for

Growth of the Autoimmune and Asthma/Atopic Dermatitis Classes Largely Stemmed from Increased Utilization, Not Higher Prices

A table titled “Growth of the Autoimmune and Asthma/Atopic Dermatitis Classes Largely Stemmed from Increased Utilization, Not Higher Prices” with two rows of data showing that the Autoimmune class saw an 8.8% utilization trend and 0.9% price growth while Asthma/Atopic Dermatits saw a 34.6% utilization trend but -3.8% price growth.

Graph - Growth of the Autoimmune and Asthma/Atopic Dermatitis Classes
…But We Drove Significant Trend Reductions in Some Major Specialty Categories
-9.8%
Trend Year-Over-Year for Multiple Sclerosis (MS) Treatments

Contributors to the Decrease in MS Drug Trend:

New Generic Availability

In the last two years, three generic MS drugs entered the market creating new opportunities to optimize cost savings for our clients.

Optimized Supply

We ensured that more plan members were using clinically appropriate amounts of MS drugs reducing unnecessary drug spend without sacrificing clinical outcomes.

Migraine, Diabetes and Obesity Treatments Also Fueled Non-Specialty Trend

While overall non-specialty trend was negative, three classes were responsible for the majority of positive non-specialty trend, driven in part by newer treatments.

Contribution to Non-Specialty Trend

Bar chart titled “Contribution to Non-Specialty Trend” with three data points: Migraine 1.2%; Antidiabetics 1.1%; Obesity 0.4%

Graph - Contribution to Non-Specialty Trend

New Treatments Boosted Migraine Drug Utilization

Despite being a relatively common condition, migraines are still not well understood by physicians and researchers. In recent years, the treatment landscape for migraines has shifted with a class of drugs called anti-calcitonin gene-related peptide (CGRP) antagonists that provided life-changing relief for some patients. However, they were not effective for everyone.

New treatments in this group like Nurtec ODT (rimegepant) and Ubrelvy (ubrogepant) have been shown to be more effective, safer and require less frequent administration than older alternatives. This means that they offer relief for more patients – leading to an increase in utilization.

We ensure our clients and their members have access to the best treatments while balancing treatment costs by using formularies and utilization management strategies to support clinically appropriate options at the lowest net cost.

Nurtec and Ubrelvy Account for Nearly 3/4 of All Gross Cost Growth in the CGRP Receptor Antagonist Migraine Class

The chart shows that gross cost per member per month increased from $1.05 to $1.82

Graph - Nurtec and Ubrelvy

Newer Medication Classes Drove Nearly All Growth in Diabetes Treatments

The prevalence of diabetes means that it continues to have a significant impact on non-specialty trend. We continue to see growth in utilization of newer diabetes medication classes – incretin mimetic agents and SGLT2 inhibitors – that have shown they can effectively control diabetes and other comorbid conditions such as kidney disease, heart disease and heart failure.

Utilization of Antidiabetic Medications

Chart titled “Utilization of Antidiabetic Medications” showing the years 2018 - 2021. The data shows percentage increase of Days Supply Per Member Per Month x100 by GPI-4 with the following values

  • 2018: All others 87%; IMAs: 6%; SGLT2: 7%
  • 2019: All others 84%; IMAs: 7%; SGLT2: 8%
  • 2020: All others 81%; IMAs: 8%; SGLT2: 10%
  • 2021: All others 78%; IMAs: 10%; SGLT2: 13%
Graph - Utilization of Antidiabetic Medications

2018-2019 figures are obtained using the Q4 2019 commercial cohort, whereas 2020-2021 figgures are obtained using the Q42021 YTD commercial cohort. Incretin Mimetic Agents. CVS Health Q4 ’21 YTD Commercial Cohort, Non-Specialty Utilization, Jan 2020-Dec 2021, pre-discount.
Source: PBM Analytics, January 2021.

Because of these newer medication classes, new treatment guidelines were put in place recommending these treatments for type 2 diabetes patients, leading to this class taking away share from the older DPP-4 class of diabetes treatments. We expect that generics for some common diabetes treatments will be approved in 2022 and 2023, leading to lower costs in this category.

We also work with clients and their members to limit the impact of diabetes on cost and improve health through programs like Pharmacy Advisor, designed to proactively intervene and improve adherence to chronic disease treatments, as well as nutrition support with our point solutions management offerings, CVS MinuteClinic Weight Loss Program and Nutrition Coaching and Services pilot program at CVS HealthHUB locations in Phoenix, Arizona. By supporting better health and prevention today, we can lower the impact of chronic conditions like diabetes on drug spending and on member health.

Obesity Medication Trend Grew Rapidly

Rising levels of obesity in the United States, coupled with comorbidities, have driven interest in new treatments that can aide weight loss. Historically seen as a lifestyle challenge, medical professionals are re-evaluating how we look at and treat obesity given its proven links to chronic conditions like diabetes and heart disease.

Utilization and Cost of Anti-Obesity Medications Rose Sharply

Chart titled “Utilization and Cost of Anti-Obesity Medications Rose Sharply” showing that Daily Supply Per Member Per Month x 100 grew by 15% from Q3 2020 to Q3 2021 from 22.1 to 25.3 and that Gross Cost Per Member Per Month x 1000 grew by 23% from Q3 2020 to Q3 2021 from $0.78 to $0.95. The medications included were Saxenda, CONTRAVE, XENICAL, Wegovy, BELVIQ and alli.

Graph - Utilization and Cost of Anti-Obesity Medications Rose Sharply

This year, we saw a marked rise in trend due to drugs like Saxenda (liraglutide) and Wegovy (semaglutide) which showed the ability to help patients lose weight when combined with diet and exercise.

Currently, only about half of CVS Caremark clients cover weight loss medications – but clinical data is being collected on this class of medication. However, given the significant and numerous comorbidities associated with obesity, there is a clear benefit to health and to health care costs from weight loss. If clinical evidence shows that these drugs can help avoid the long-term complications associated with obesity and the health care costs they incur, this could lead to additional coverage in the future.