Express Scripts 2007 Drug Trend Report

Exhibit 15
Impact of New Drugs on 2007 Cost and Utilization
Percent of 2007 Cost
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0
Percent of 2007 Prescriptions
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0
2004-2007
2001-2003
1998-2000
1995-1997
1994 and Before
Member Cost Trend
The change in per-prescription costs is shared proportionally by both plan sponsors and members through
year-to-year changes in member copayments. To examine how the per-prescription cost increases were
being shared by members and plan sponsors, we segmented the per-prescription cost trend by member
cost and net plan sponsor cost. Because member cost for specialty medications is typically much lower
as a proportion than member cost for nonspecialty medications, we examined nonspecialty, specialty
and total per-prescription cost trends separately.
If plan sponsors were attempting to control costs by shifting a greater proportion of costs to members
through increased member cost, the overall trend for plan sponsors would be lower relative to member
per-prescription share. However, from 2006 to 2007, member share of per-prescription costs remained
relatively flat, decreasing by 0.4% for nonspecialty and increasing by 0.3% for specialty.
Trend
Exhibit 16
Changes in Member and Plan Sponsor Per-Prescription Costs 2006 to 2007*
Nonspecialty Specialty Total
Member Cost -0.4% 0.3% -0.3%
+ Plan Sponsor Cost 2.5% 8.3% 3.2%
= Cost per Prescription 2.1% 8.6% 2.9%
X Utilization 2.6% 5.0% 2.6%
= All Drugs 4.7% 14.0% 5.5%
* The percentage contribution of each factor may not total the All Drugs percentage increase because the total is
multiplicative, not additive. Final results may differ due to rounding.
Influencing the negative cost-per-prescription trend for members was the brand/generic mix. Members
saved an average of $15 per prescription when they moved from a brand to a generic. Although plan
sponsors saved as well, given inflation and therapeutic-mix trends, plan sponsors paid a higher overall
portion of total cost in 2007 compared to 2006. Total cost includes administrative fees, taxes and
dispensing fees.
Exhibit 17 on the next page shows that member cost as a proportion of total prescription cost decreased
from 24.5% to 23.6% for nonspecialty medications. Proportionally, member cost of total specialty costs
remained the same — leading to a reduction of approximately one percentage point in the proportion of
total prescription cost paid by members from 2006 to 2007.
express scripts 2007 drug trend report 15