Adalimumab, Insulin Glargine, Etanercept Top 2018 Drug Spending List

The top 3 drugs in 2018 in the United States by spending were adalimumab, insulin glargine, and etanercept, according to a study in The American Journal of Health-System Pharmacy, which also predicted that drug spending will grow 4% to 6% this year.
Allison Inserro
July 18, 2019
The top 3 drugs in 2018 in the United States by spending were adalimumab, insulin glargine, and etanercept, according to a study in The American Journal of Health-System Pharmacy, which also predicted that drug spending will grow 4% to 6% this year.

Most of the spending will occur for drugs administered in clinics, which are predicted to grow 11% to 13% this year.

Comparing manufacturing purchasing data obtained from the IQVIA National Sales Perspectives database from 2017 to 2018, researchers found a 5.5% increase in spending in 2018, to $476.2 billion. Growth came from purchases of new products, price changes for existing drugs (including brands and generic drugs), and increased utilization. Home care had the largest growth of any sector (30.6%), followed by clinics.

For 2018 expenditures, adalimumab had $19.1 billion in spending, followed by insulin glargine ($9.3 billion), and etanercept ($8 billion). However, adalimumab and etanercept had slower growth last year (11.9% and 0.8%, respectively) compared with previous years (20.6% and 8.9%, respectively, in 2017 and 27.6% and 11.2%, respectively, in 2016).

Insulin glargine was 1 of 3 insulin products and 6 antidiabetic agents on the top 25 list; expenditures for insulin aspart ($5.9 billion in 2018) and insulin lispro ($5.7 billion in 2018) continued to increase, by 6.1% and 7%, respectively, compared to 2017. There was also increased spending on the noninsulin antidiabetic agents sitagliptin (12.8%), liraglutide (21.9%), and dulaglutide (68.5%) in 2018 compared with 2017.

In addition, despite the fact that biosimilar versions of originator biologics (bevacizumab, trastuzumab, and rituximab) could reach the market in the near future, actual cost savings are uncertain, the report said.

In the ASHP Foundation’s Pharmacy Forecast 2019 report, a question regarding the potential for biosimilars to produce a cost savings of 25% in the next 5 years received a “very likely” answer from just 13% of respondents; 45% felt it was “somewhat likely,” indicating little confidence that biosimilars will provide even a modest cost savings in the next several years, the report noted.

The top 25 drugs by expenditures in nonfederal hospitals ($35.8 billion) and clinics ($80.5 billion) was dominated by specialty drugs. Biologics and cancer drugs contributed most of increase in drug spending in clinics in 2018. Spending on specialty drugs in 2018 was $217.7 billion for all sectors, or 45.7% of total prescription drug expenditures; that is consistent with an Express Scripts report from earlier this year.

In clinics, infliximab, the drug with the highest spend since 2013, had $3.8 billion in expenditures (including both the branded product and biosimilars) last year, up 0.2% compared with 2017. Infliximab was followed by nivolumab and pembrolizumab, each with $3.4 billion of spending (up 35.4% and 88.4%, respectively, compared with 2017).

Pegfilgrastim and rituximab rounded out the top 5, each with expenditures over $2.8 billion.

Specialty drug expenditures increased 11.1% in 2018 compared with 2017, a rate faster than the overall market growth rate of 5.5%. Three sectors accounted for 87% of spending on specialty drugs: mail-order pharmacies ($93.4 billion, or 42.9%); clinics, including physician offices and outpatient clinics ($62.7 billion, or 28.8%); and retail pharmacies ($32.7 billion, or 15%).

The top 5 specialty drugs in mail-order pharmacies (adalimumab, etanercept, ustekinumab, dimethyl fumarate, and glatiramer) were different from the top 5 specialty drugs in clinics (infliximab, nivolumab, pembrolizumab, pegfilgrastim, and rituximab), a reflection of heavily infusion-based specialty pharmacy practice in clinics.

Health-system pharmacy executives should carefully examine local drug utilization patterns to determine their own organization’s anticipated spending this year, the report said.

Schumock GT, Stubbing J, Hoffman JM, et al. National trends in prescription drug expenditures and projections for 2019. Am J Health-Syst Pharm. 2019;76(15): 1105-1121. doi: 10.1093/ajhp/zxz109.



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