Home » Blog » U.S. Drug Prices May Rise 12% and Express Scripts Will Exclude 66 Brand Name Drugs from 2015 Formulary

U.S. Drug Prices May Rise 12% and Express Scripts Will Exclude 66 Brand Name Drugs from 2015 Formulary


IP Blog | Dave Melin | November 30, 2014

BioBlogWeeklyThis week in healthcare, Kaiser predicts drug prices will rise 12% and what will the Republican election wins mean for healthcare reform and the ACA?

Drug prices expected to rise nearly 12% this year

According to Kaiser Health News, health costs are expected to rise 11.7% in 2014, partly due to Sovaldi and Harvoni, two high-cost hepatitis C drugs. This and other factors “will send the cost of pharmaceuticals in United States to reach between $375 billion and $385 in 2014, according to the IMS Institute for Healthcare Informatics.” The good news: “the price spike is expected to be relatively short-lived. IMS has projected drug costs will increase between 7 percent and 9 percent in 2015. That’s attributable in part to the market adjusting to the hepatitis C drugs, as well as two pricey pharmaceuticals–leukemia drug Gleevac and the antipsychotic medication Abilify–that will go off-patent and likely be supplanted by generic drugs.”

Benefits plans excluding more drugs as costs rise

A new report from Bloomberg suggests that health plans will continue to increase the number of drugs excluded from their plans for cost reasons. According to the report, “Express Scripts will exclude 66 brand-name drugs from its main formulary, or list of drugs that it covers, in 2015. This marks an increase from 48 in 2014. Likewise, CVS will exclude 95 drugs, up from about 70 in 2014.”

What do Republican election wins mean for healthcare reform?

As the dust settles after the midterm elections, analysts are looking ahead to what election results will mean for the Affordable Care Act. There may be a push to repeal the medical device tax and there is much talk about opposition to the ACA, but one source notes that “what the Republicans aren’t apt to do in this political climate is introduce an alternative healthcare reform bill.”

Specialty Drugs a Rising Healthcare Cost

In the aftermath of pharma giant Genentech’s decision to decrease their number of distributors, multiple parties spoke out to try to convince them to “reverse its decision to primarily use specialty drug distributors instead of wholesale distributors for its widely used anticancer treatments”. In the midst of this and other specialty drug cost issues, many are wondering how — or who — to shoulder the increased costs?

Debating the Oncologist’s Role in Defining the Value of Cancer Care: We Have a Duty to Society

In a recent Journal of Clinical Oncology article, author Reshma Jagsi, MD argues that in the face of the continuing debate over rising healthcare costs, “physicians are more than bystanders.” Jagsi then goes on to explore rationing and the “Choosing Wisely” campaign, arguing that oncologists “must develop a culture of financial stewardship within our profession, convey to patients why certain tests or treatments are inappropriate, and exhibit restraint even when perverse incentives exist.”

New ASCO Study Aims to Learn from Patient Access to Targeted Cancer Drugs Used Off-Label

This week ASCO announced it would “launch a first-ever study that will offer cancer patients access to molecularly-targeted cancer drugs and collect ‘real-world’ data on clinical outcomes to help oncologists learn the best uses of these drugs outside of approved indications.” This will be the first ever ASCO-led clinical trial and will be called the “Targeted Agent and Profiling Utilization Registry (TAPUR) Study”.

Judge rules against White House on Affordable Care Act

In Oklahoma, a federal judge has ruled that “Obamacare subsidies cannot go to residents of states that are not running their own insurance exchanges.” This is the second time a federal judge has ruled against ACA subsidies.

ACOs will replace insurers, former Obama advisor says

Ezekiel Emanuel, former White House health care advisor, “expects insurers to be obsolete by 2025. By then, ACOs will have assumed both clinical and financial risks for their members, thereby eliminating the need for insurers, which exclude some consumers and impose administrative barriers.” He also stated that he didn’t think the United States would ever have a single-payer system.

Comparing Standard Versus Prosocial Internet Support Groups for Patients With Breast Cancer: A Randomized Controlled Trial of the Helper Therapy Principle [study]

A recent study published in the Journal of Clinical Oncology examined the potential mental health benefits of participating in an Internet Support Group (ISG) focused on helping others. The study found that “despite the successful manipulation of supportive behaviors, the [test group] did not produce better mental health outcomes in distressed survivors of breast cancer” than the control group.

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