Prices for and Spending on Specialty Drugs in Medicare Part D and Medicaid: An In-Depth Analysis: Working Paper 2019-02
In 2015, brand-name specialty drugs accounted for about 30 percent of net spending on prescription drugs under Medicare Part D and Medicaid, but they accounted for only about 1 percent of all prescriptions dispensed in each program.
By Anna Anderson-Cook, Jared Maeda, and Lyle Nelson (all of CBO)
In this working paper, the Congressional Budget Office examines the prices paid for specialty drugs and spending on those drugs in Medicare Part D and Medicaid from 2010 to 2015. Specialty drugs treat chronic, complex, or rare conditions, frequently have high prices, and may require special handling or monitoring of patients. The retail prices paid to pharmacies for brand-name specialty drugs are similar in Medicare Part D and Medicaid, but net prices are much higher in Medicare Part D because rebates from manufacturers are substantially lower than in Medicaid. In 2015, the weighted average net price for 50 top-selling brand-name specialty drugs in Medicare Part D was $3,600 per “standardized” prescription—a measure that roughly corresponds to a 30-day supply of medication—whereas the weighted average net price for the same set of drugs in Medicaid was $1,920. In Medicare Part D, net spending on specialty drugs rose from $8.7 billion in 2010 to $32.8 billion in 2015. In Medicaid, net spending on specialty drugs roughly doubled over the same period, reaching $9.9 billion in 2015. For beneficiaries in the Medicare Part D program who took brand-name specialty drugs, average annual net spending on such drugs per beneficiary (in 2015 dollars) increased from $11,330 in 2010 to $33,460 in 2015.