Understanding Trends in Drug Super Spender Members

Researchers from Prime Thearapeutics presented data at AMCP Nexus 2019 in National Harbor, MD, where they examined the number of drug super spender members in the commercially insured population.

Drug super spenders are categorized as members who incur $250,000 or more in drug costs annually. The rise in treatments and drugs for rare diseases and gene therapies are the cause of these uniquely high-cost members.

“Health plans need to be aware of this important health care cost driver, understand the growth rate in drug super spenders, and ensure cost-effectiveness of these new therapies to maintain health insurance affordability,” explained the researchers.

The researchers examined members with any period of enrollment between January 2016 and December 2018, from a 17.7 million commercially insured population. From this data, they identified allowed cost for pharmacy claims and all medical benefits claims.

“In 2016, 2,994 members with >$250 thousand (k) drug cost per member accounted for $1,324 million (M) drug spend. In 2018, >$250k drug cost per was 4869 members (63% increase) for $2119 M drug spend (60% increase),” according to the researchers.

Further, the researchers found that “the number of unique members in the highest cost band, ≥$750k, was 256 in 2016 and 354 in 2018 (38% increase), with their total drug cost increasing from $297 M in 2016 to $417 M in 2018 (40% increase).”

According to the data, the researchers concluded that the number of super spender members increased from 63% from 2016 to 2018 and accounted for over $2 billion in drug expenditures.

“Health plans need robust strategies for anticipating, tracking, and optimizing drug and one-time (eg, gene) therapy for these members as drug super spenders are expected to rapidly grow with new rare drug treatments, gene and one-time therapies approvals,” concluded the researchers.

—Edan Stanley