INSIGHTS FOR AFFORDABILITY EFFORTS: ANALYZING DRUG AND NON-DRUG SPEND VIA STATE APCDS
Author(s)
Swetha Ramanathan, MPH, PhD1, Benjamin Cohen, MPH, PhD1, Elizabeth Brouwer, MPH, PhD2, Rainie Wu, MS2, Thomas Majda, MS, PharmD3, William Wong, MS, PharmD3, Daniel Sheinson, PhD3, Josh Carlson, MPH, PhD2, Brett McQueen, PhD4;
1Stage Analytics, Suwanee, GA, USA, 2Curta, Seattle, WA, USA, 3Genentech, South San Francisco, CA, USA, 4University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Denver, CO, USA
1Stage Analytics, Suwanee, GA, USA, 2Curta, Seattle, WA, USA, 3Genentech, South San Francisco, CA, USA, 4University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Denver, CO, USA
OBJECTIVES: All payer claims databases (APCDs) are used by states to analyze healthcare spending trends to inform policy and planning decisions. As part of efforts to curb overall healthcare spending, organizations, such as prescription drug affordability boards (PDABs), have been established to focus on drug spend. Using OR and CO APCDs, we sought to characterize non-drug and drug spend to better inform state efforts to address affordability.
METHODS: OR and CO APCDs were examined to assess annual drug and non-drug spending from 2021-2023. Spend was stratified by payer type, patient out-of-pocket (OOP) cost, and health plan costs. Drug spend was calculated with and without the inclusion of medical benefit drugs. All spending was inflated to 2025 dollars.
RESULTS: In OR (N=3,747,605), average annual drug spend per patient was $1,854 (SD: $13,266; median (IQR): $38 ($0-$428)) and average annual non-drug spend was $4,801 (SD: $21,459; median (IQR): $461 ($0-$2,461)) representing 28% and 72% of total healthcare spending in 2023, respectively. In CO (N=3,778,777) average annual drug spend per patient was $2,311 (SD: $16,291; median (IQR): $78 ($0-$549)) and average annual non-drug drug spend was $6,817 (SD: $29,553; median (IQR): $1,197 ($276 - $4,212)) representing 25% and 75% of total healthcare spending in 2023, respectively. Similar results were seen across years, payer type, health plan spend, and patient OOP spend. Inclusion of medical benefit drugs increased the drug spend proportion by 6% in OR and 8% in CO in 2023. In OR from 2021 to 2023, drug spend grew at an average annual rate of 4.0% whereas non-drug spend grew 7.1% (CO: 4.6% vs 9.8%).
CONCLUSIONS: Increasing faster than drug costs from 2021 to 2023 in OR and CO, non-drug healthcare costs are the largest portion of the overall healthcare spend and should be a target for states’ efforts to address affordability.
METHODS: OR and CO APCDs were examined to assess annual drug and non-drug spending from 2021-2023. Spend was stratified by payer type, patient out-of-pocket (OOP) cost, and health plan costs. Drug spend was calculated with and without the inclusion of medical benefit drugs. All spending was inflated to 2025 dollars.
RESULTS: In OR (N=3,747,605), average annual drug spend per patient was $1,854 (SD: $13,266; median (IQR): $38 ($0-$428)) and average annual non-drug spend was $4,801 (SD: $21,459; median (IQR): $461 ($0-$2,461)) representing 28% and 72% of total healthcare spending in 2023, respectively. In CO (N=3,778,777) average annual drug spend per patient was $2,311 (SD: $16,291; median (IQR): $78 ($0-$549)) and average annual non-drug drug spend was $6,817 (SD: $29,553; median (IQR): $1,197 ($276 - $4,212)) representing 25% and 75% of total healthcare spending in 2023, respectively. Similar results were seen across years, payer type, health plan spend, and patient OOP spend. Inclusion of medical benefit drugs increased the drug spend proportion by 6% in OR and 8% in CO in 2023. In OR from 2021 to 2023, drug spend grew at an average annual rate of 4.0% whereas non-drug spend grew 7.1% (CO: 4.6% vs 9.8%).
CONCLUSIONS: Increasing faster than drug costs from 2021 to 2023 in OR and CO, non-drug healthcare costs are the largest portion of the overall healthcare spend and should be a target for states’ efforts to address affordability.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HPR132
Topic
Health Policy & Regulatory
Topic Subcategory
Public Spending & National Health Expenditures
Disease
No Additional Disease & Conditions/Specialized Treatment Areas