Enbrel, Humira Top Prescription Drug Spending for Those Covered Through Large Employer Plans

A recently released analysis from the Kaiser Family Foundation (KFF) sheds new light on how rising drug prices are impacting patients' out-of-pocket spending on drugs, as well as the budgets of private and public payers.

The analysis drew from data included in the National Health Expenditures Accounts database, the Truven Health Analytics MarketScan Commercial Claims and Encounters Database, and CMS.

According to KFF, the top 50 drug products by spending in 2016 were responsible for a substantial share of total drug pending, yet they accounted for a relatively small share of total prescriptions among large employer plans (39% share of spending vs 8% share of prescriptions), Medicare Part D (43% share of spending vs 15% share of prescriptions), and Medicaid (41% share of spending vs 8% share of prescriptions).

The top 5 drugs products with the highest total spending in 2016 accounted for approximately 10% of total prescription drug spending among large employer plans, Medicare Part D, and Medicaid. Among large employers, Humira ($4.9 billion) and Enbrel ($2.4 billion), both of which have FDA-approved but unlaunched biosimilar options, were responsible for the greatest share of spending.

In Medicare Part D, Harvoni ($4.4 billion) and Revlimid ($2.6 billion) topped the spending charts for 2016, with Lantus Solostar ($2.5 billion) being the drug with the third highest spending under Part D. Medicaid spent the most on Harvoni ($2.2 billion), followed by Humira ($1.3 billion).

Humira and Enbrel also had some of the highest average out-of-pocket spending per user in both large employer plans and Medicare Part D in 2016; in employer plans, patients spent an average of $1123 and $1134 on the 2 branded drugs, respectively. In Part D, they paid $1587 on the pen presentation of Humira and $1610 on Enbrel.

Reflected in the above numbers is the fact that, on average, people covered in Medicare Part D plans spend more out of pocket than those covered through their employer plans. On average, in 2016, Medicare Part D enrollees spend $365 out of pocket on drugs, compared with $132 for those insured through large employers.