Coventry has released part 4 of their 2017 Drug Trends series, this one is titled “Topicals, Specialty Medications & Regulatory Development”.

The analysis uses data from calendar year transactions billed through Coventry’s Pharmacy Benefit Management (PBM) program, First Script, and transactions from medical bill review. The managed data comes from retail and mail-order, adding prescriptions from Coventry’s extended network. Unmanaged data comes from out-of-network prescriptions that are processed through bill review.

Topical and specialty drugs may represent a small portion of aggregate prescriptions (6%) but account for 17.9% of total aggregate costs.

Topicals alone represent 4.8% of total prescriptions and 12.8% of total drug costs. They are increasing in unmanaged spaces (costs per claim increased 29.4% in 2017) but are more controlled in managed care environments where costs per claim decreased by 1.9% in 2017. Cost per script in the managed care space increased 4.9% but that is lower than the increase seen in the past few years- cost per script experienced a high of 20.9% in 2015. On the unmanaged side of things, cost per script increased 17.9% in 2017. In managed care trends, the top 5 topical medications remained consistent and represented 73.4% of total scripts. The Lidoderm Patch accounted for almost one-third of managed topical scripts- though utilization per claim and cost per prescription both decreased. In unmanaged care trends, the top 5 topical medications represented 32.1% of total scripts, and though Pennsaid represented 5.5% of total scripts it represented almost 20% of total costs. Utilization per claim and cost per script both significantly increased for Pennsaid, Lidocaine ointment and the Velma patch in the unmanaged space.

Specialty medications account for 5.1% of prescription drug costs but represent just 1.2% of drug utilization. They are used for complex and chronic conditions. Costs per claim in the managed space increased 7.7% (attributed to an increasing cost trend for HIV/AIDS medications) while they decreased in unmanaged spaces by 22.5% (attributed to a downward cost trend for anemia medications which fell 96.1%). In the managed space, the top 5 conditions represent 65.3% of all specialty costs in the managed group compared to 83.3% of the costs in the unmanaged group.

Topical medications are not typically the first line of recommended treatments and can be very expensive, and specialty drugs are a quick growing pharmaceutical section. They should both be watched for appropriate utilization to make sure patients are receiving the best treatment while accounting for cost and recommended treatment options.

Read Part 4 of the series here.