The United States is seeing a surge of innovative specialty therapeutics coming onto the market, many of which offer potential treatments for conditions that previously didn’t have one. But many of these newer therapies are launching with expensive price tags, driving up spending on health care services. A Prime Therapeutics LLC study found a huge increase in people who have annual drug spend of at least $250,000 — so-called “drug super spenders”— from 2016 to 2019.
Researchers analyzed pharmacy and medical benefit claims from a commercially insured population of 17.9 million members between January 2016 and December 2019. They defined “cost” as plan and member cost share after network discounts but did not include manufacturer rebates or coupons. For drug super spenders, researchers used diagnosis codes to determine a clinical condition category based on their drug use.