Data released this week by Express Scripts indicates that 2012 saw a decrease in spending on traditional prescription drugs for the first time in more than 20 years. Among America’s commercially insured population, spending on common pharmaceuticals — including those for conditions such has high cholesterol or blood pressure — declined 1.5% last year.

Express Scripts, however, says the decline was offset by an 18.4% rise in spending on specialty medications. The aggregate trend for the year was a bump of 2.7%, similar to that of 2011. Fewer than 2% of the general population uses specialty prescriptions, the new report says, but specialty spending made up 24.5% of the total drug spend within the pharmacy benefit, the largest share on record.

The “patent cliff” of 2012 saw the release of many lower-cost generics and unit costs decreased in seven of the 10 traditional therapy classes.

“The first-ever decrease in traditional drug spending is the latest chapter of an ongoing success story for our utilization management programs and for an increased interest in generic medications, home delivery pharmacy and more focused retail pharmacy networks,” says Glen Stettin, M.D., Express Scripts senior vice president of clinical, research and new solutions.

“These same principles of effective management solutions and increased drug competition are necessary to the country’s effort to rein in specialty drug costs,” Stettin says. “The plan sponsors who implement our specialty management programs are already seeing much lower growth in specialty drug costs than the national average. And increased drug competition, in the form of biosimilars, is necessary to offer more affordable medication for patients afflicted with these complex specialty conditions.”

Diabetes medications were the most costly prescriptions for the second consecutive year; diabetes drug spending grew 11% in 2012. The largest single-year increase in cost was for prescriptions related to hepatitis C: 33.7%.

According to Express Scripts, the difference between the 2012 decline in cost for generic medications (-24%) and the rise in cost of the most-used name brand ones (+12.5%) is the largest disparity in the past five years.

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