By Nancy Matocha, Vizient
Vizient, Inc. projects a 3.42% increase in hospital pharmaceutical spend in its Summer Pharmacy Market Outlook, released July 31. The overall increase, forecasted for the year beginning January 2024, is being driven by specialty pharmaceuticals and medications in the neurology service line. In addition, the Outlook demonstrates the continued decline in demand for remdesivir, which topped the list of Vizient member spend during the height of the Covid-19 pandemic and has since fallen to No. 13. View the 2023 Summer Pharmacy Market Outlook.
Specialty drugs, which treat high-cost, complex or chronic conditions such as cancer, infectious-, autoimmune-, and pulmonary conditions, continues to see an expansion in the number of medications approved as treatment options. Not only are three of the top five medications in Vizient member spend classified as specialty — including adalimumab (Humira); ustekinumab (Stelara); and denosumab (Prolia, Xgeva) — two specialty oncology medications approved last year are already in the top 100 drugs of Vizient member spend: Teclistimab (Tecvayli) and tebentafusp (Kimmtrak). The former is used in the treatment of adult patients with relapsed or refractory multiple myeloma; the latter is the only FDA-approved treatment for unresectable or metastatic uveal melanoma.
"Specialty medications overall accounted for 51% of spending in 2022," said Carina Dolan, associate vice president, clinical oncology, pharmacoeconomics & market insights. "We're advising health systems to ensure their teams are positioned to manage both medical and pharmacy billing nuances of specialty pharmaceuticals, provide support for prior authorizations and patient financial assistance in multiple settings."
Neurology
The neurology service line is experiencing new drug development as well as increases in pricing, driving provider utilization and costs. Ocrelizumab (Ocrevus) has historically been a significant part of the overall Vizient member spend for the treatment of multiple sclerosis and is the seventh top drug by size of projected price increase. However, in December the FDA approved ublituximab (Briumvi), an anti-CD20- monoclonal antibody. With shorter infusion duration and a lower wholesale acquisition cost, it will be the lowest cost monoclonal antibody approved to treat relapsing forms of multiple sclerosis and may help healthcare organizations lower costs.
For migraine treatment, the calcitonin gene-related peptide class (CGRP) has grown over the past few years in spend and in treatment options. Annual treatment cost of monoclonal antibody CGRP therapy is around $6,900, with a 73% increase in Vizient member spend from April 2021-March 2022 compared with April 2022-March 2023, the uptick indicating greater utilization.
Remdesivir declines in member spend
Since its debut on the top 10 drug list in Vizient member spend in summer 2021, remdesivir, used in the treatment of Covid-19, has reflected the nation's infection rate. While it retains its number one overall ranking in the acute care segment of the market, it has declined 65% in total Vizient member spend from its peak in the January 2022 Pharmacy Market Outlook, when it held the No. 1 spot, representing almost $1 billion in health system spend.
"The total decline in remdesivir spend for our Vizient pharmacy program participants is ultimately due to fewer adults and pediatric patients being treated for Covid-19 across the country," Dolan said. "The decline is good news for patients and the providers that serve them."
Biosimilars watch
The launch of adalimumab biosimilars in January marked the end of a 20-year competition-free period for Humira, an anti-inflammatory, and the top drug in Vizient member spend. There are two approved biosimilars in the market and eight ready to launch by the end of summer. Broad integration into hospital pharmacy formularies is expected six to 12 months following introduction. In oncology, three biosimilar monoclonal antibodies that launched in 2019 – bevacizumab (Avastin), trastuzumab (Herceptin), and rituximab (Rituxan) – have seen a significant uptake in the market.
Biosimilars account for nearly 25% of spend overall as compared to their originator products, the Outlook shows. Currently, there are 40 approved biosimilars with projected savings of $181 billion over the next five years, reaching across multiple services lines, according to the Center for Biosimilars.
Projections in the Vizient Pharmacy Market Outlook are based on the top 85% of Vizient Pharmacy Program participants' aggregated purchasing volume. Vizient is the largest member-driven healthcare performance improvement company in the nation. Learn more about the Vizient Pharmacy Market Outlook.