U.S. prescription drug spending grew 13.1 percent last year, thehighest increase in a decade, Express Scripts said Tuesday.

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The spike in drug prices was primarily driven by new hepatitis Ctherapies with high price tags and the "exploitation of loopholes"for compounded medications, the prescription benefits managersaid.

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Read: Employersstruggling to contain escalating drug costs

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Specialty medication — treatments for conditions such asmultiple sclerosis and cancer — more than doubled in 2014,accounting for more than 31 percent of total drug spending in2014.

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Hepatitis C medications accounted for 45 percent of the totalincrease in specialty spend despite having the second-lowestprescription volume among the top 10 specialty conditions. Spendingon those drugs increased by 743 percent in the last year.

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Medicare plans — required to follow Medicare Part D formularyguidelines — were the hardest hit, as their annual specialty drugspend increased 45.9 percent, Express Scripts said.

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“For the past several years, annual drug spending increases havebeen below the annual rate of overall health care inflation in theU.S., but that paradigm is shifting dramatically as prices formedications increase at an unprecedented and unsustainable rate,”said Glen Stettin, senior vice president, cinical, research and newsolutions at Express Scripts.

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The Express Scripts report also found:

  • Drugmaker consolidation and drug shortages also led to increasesin traditional drug trend, which rose to 6.4 percent in 2014.

  • Diabetes remains the leading traditionaltherapy class for a fourth straight year based on total costs,and Express Scripts expects double-digit increases in spend inthis class over the next three years.

  • Cost for medications to treat pain increased 15.7 percent in2014.

  • Inflammatory conditions, which include treatments for rheumatoidarthritis and psoriasis, maintained their position as the costliestspecialty drug class due to expanded indications and increasedprevalence of treatment.

“Now, more than ever, plans need to tightly manage the pharmacybenefit, implement smarter formularies, control compoundedmedication use and offer the right clinical support to ensure allpatients are able to achieve the best possible health outcomes at aprice our country can afford,” Stettin said.

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