For its first annual drug trend report as a part of Cigna Corp., Express Scripts Holding Co. said it had achieved a record low drug trend of 0.4% across its clients’ employer-sponsored commercial plans in 2018. Overall, the PBM reported savings of $45 billion for its clients last year, AIS Health reported.

The PBM cited “an unprecedented 0.3% decline” in per-beneficiary drug spending across Medicare plans. Overall, there was a 1.4% decrease in unit cost trend, which allowed clients to absorb a 1.1% increase in utilization, the PBM said. Oncology replaced diabetes as Medicare’s top therapy class by per member per year spend.

Express Scripts also reported falling unit drug costs for employer, Medicare and Affordable Care Act exchange plans. On the specialty side, the PBM said that although list prices for brand-name specialty drugs rose by 7.1% in 2018, specialty drug costs increased by a lower 2.1% for its employer-sponsored plans, 2.4% for its Medicare plans and 2% for its exchange plans.

“ESI’s report reflects a broader pattern that we are tracking industry-wide as it relates to drug trend,” says Josh Golden at Arthur J. Gallagher & Co.’s Solid Benefit Guidance.

“On the non-specialty side, the absence of any significant new blockbuster brands and the continued deflation of generics has offered plans some much-needed cost relief. These trends have helped offset the mounting cost and utilization increases that we are seeing for specialty products,” Golden says. “As a result of these opposing forces, trend is hovering in the low single digits. This is welcome news for plan sponsors.”