2006 drug trend julayna meyer, r.ph, mba vice president trend management
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2006 Drug Trend
Julayna Meyer, R.Ph, MBAVice President Trend Management
2 2007 Express Scripts, Inc. All Rights Reserved.
2006 Drug Trend
I. Overall trend and spend
II. Future Drug Trend Projections
III. Key Therapy Classes
IV. The Results of Active Management
V. Ongoing opportunities to maximize the benefit
3 2007 Express Scripts, Inc. All Rights Reserved.
2006 Top DTC Advertised Classes
$100 Million
$200 Million
$300 Million
$400 Million
$500 Million
Source: JP Morgan March 19, 2007 Prescription Pad
$179Erectile Dysfunctio
n
$498Hypnotics
$446Cholesterol
$357Asthma
$221Osteoporosis
Hypnotics trend: 36.9%Hypnotics trend: 36.9%
4 2007 Express Scripts, Inc. All Rights Reserved.
What Do We Mean By “Drug Trend”?
• We report total ingredient cost year over year– Plan design decisions determine cost-sharing
• We report Express Scripts commercial book of business– Plan specific results available through your
Account Management team
• We track specialty separately
More detailed information can be found in our Drug Trend Report
5 2007 Express Scripts, Inc. All Rights Reserved.
Component 2001:02
2002:03
2003:04
2004:05
2005:06
Price
Units per Rx
Brand/Generic Mix
Therapeutic Mix
= Cost per Rx
X Utilization
= Common Drugs
+ New Drugs
Overall Rx Trend
Components of Rx Cost Trend*
* Excluding Specialty starting in 2003
Price: The difference in average price per unit of common drugs compared to previous year. Typical drivers include market dynamics and competition.
Price: The difference in average price per unit of common drugs compared to previous year. Typical drivers include market dynamics and competition.
6 2007 Express Scripts, Inc. All Rights Reserved.
Component 2001:02
2002:03
2003:04
2004:05
2005:06
Price 7.5% 6.6% 6.0% 5.3% 4.3%
Units per Rx
Brand/Generic Mix
Therapeutic Mix
= Cost per Rx
X Utilization
= Common Drugs
+ New Drugs
Overall Rx Trend
Components of Rx Cost Trend*
* Excluding Specialty starting in 2003
7 2007 Express Scripts, Inc. All Rights Reserved.
Component 2001:02
2002:03
2003:04
2004:05
2005:06
Price 7.5% 6.6% 6.0% 5.3% 4.3%
Units per Rx
Brand/Generic Mix
Therapeutic Mix
= Cost per Rx
X Utilization
= Common Drugs
+ New Drugs
Overall Rx Trend
Components of Rx Cost Trend*
* Excluding Specialty starting in 2003
8 2007 Express Scripts, Inc. All Rights Reserved.
Brand Drug Prices UpGeneric Drug Prices Down
-8%
-4%
0%
4%
8%
Brand Prices Brand Prices Up 6.9%Up 6.9%
Brand Price Leaders:Brand Price Leaders:• Hypnotics up 13.8%Hypnotics up 13.8%• Stimulants/obesity up 10.5%Stimulants/obesity up 10.5%
9 2007 Express Scripts, Inc. All Rights Reserved.
Brand Drug Prices UpGeneric Drug Prices Down
-8%
-4%
0%
4%
8%
Brand Prices Brand Prices Up 6.9%Up 6.9%
10 2007 Express Scripts, Inc. All Rights Reserved.
Brand Drug Prices UpGeneric Drug Prices Down
-8%
-4%
0%
4%
8%
Brand Prices Brand Prices Up 6.9%Up 6.9%
Generic Prices Generic Prices Down 5.7%Down 5.7%
11 2007 Express Scripts, Inc. All Rights Reserved.
Component 2001:02
2002:03
2003:04
2004:05
2005:06
Price 7.5% 6.6% 6.0% 5.3% 4.3%
Units per Rx -0.1% 0.3% 0.2% 0.1% 0.4%
Brand/Generic Mix
Therapeutic Mix
= Cost per Rx
X Utilization
= Common Drugs
+ New Drugs
Overall Rx Trend
Components of Rx Cost Trend*
* Excluding Specialty starting in 2003
12 2007 Express Scripts, Inc. All Rights Reserved.
Component 2001:02
2002:03
2003:04
2004:05
2005:06
Price 7.5% 6.6% 6.0% 5.3% 4.3%
Units per Rx -0.1% 0.3% 0.2% 0.1% 0.4%
Brand/Generic Mix
Therapeutic Mix
= Cost per Rx
X Utilization
= Common Drugs
+ New Drugs
Overall Rx Trend
Components of Rx Cost Trend*
* Excluding Specialty starting in 2003
Brand/Generic Mix: Reflects the cost impact of increased generic use. Typical drivers: new generics and maturation of the therapy class
Brand/Generic Mix: Reflects the cost impact of increased generic use. Typical drivers: new generics and maturation of the therapy class
13 2007 Express Scripts, Inc. All Rights Reserved.
Component 2001:02
2002:03
2003:04
2004:05
2005:06
Price 7.5% 6.6% 6.0% 5.3% 4.3%
Units per Rx -0.1% 0.3% 0.2% 0.1% 0.4%
Brand/Generic Mix -2.3% -2.6% -2.6% -2.7% -2.9%
Therapeutic Mix
= Cost per Rx
X Utilization
= Common Drugs
+ New Drugs
Overall Rx Trend
Components of Rx Cost Trend*
* Excluding Specialty starting in 2003
14 2007 Express Scripts, Inc. All Rights Reserved.
Component 2001:02
2002:03
2003:04
2004:05
2005:06
Price 7.5% 6.6% 6.0% 5.3% 4.3%
Units per Rx -0.1% 0.3% 0.2% 0.1% 0.4%
Brand/Generic Mix -2.3% -2.6% -2.6% -2.7% -2.9%
Therapeutic Mix
= Cost per Rx
X Utilization
= Common Drugs
+ New Drugs
Overall Rx Trend
Components of Rx Cost Trend*
* Excluding Specialty starting in 2003
15 2007 Express Scripts, Inc. All Rights Reserved.
Top Brand/Generic Mix Changes
Rank Therapy Class
Key Generic Introduction
Therapy Class
Impact1 Antihistamines Allegra® (2005) -11.8%
2 NSAIDs Mobic® (2006) -10.7%
3 Decongestants Flonase® (2006) -10.5%
4 Narcotic Analgesics
OxyContin® (2005)Duragesic® (2005)Actiq® (2006)
-9.1%
5 Misc. Hematologics Plavix® (2006) -8.3%
6 AntihyperlipidemicsPravachol® (2006)Zocor® (2006)
-5.6%
7 Antidepressants Zoloft® (2006) -2.5%Ranked by Percent Change
16 2007 Express Scripts, Inc. All Rights Reserved.
Component 2001:02
2002:03
2003:04
2004:05
2005:06
Price 7.5% 6.6% 6.0% 5.3% 4.3%
Units per Rx -0.1% 0.3% 0.2% 0.1% 0.4%
Brand/Generic Mix -2.3% -2.6% -2.6% -2.7% -2.9%
Therapeutic Mix
= Cost per Rx
X Utilization
= Common Drugs
+ New Drugs
Overall Rx Trend
Components of Rx Cost Trend*
* Excluding Specialty starting in 2003
Therapeutic Mix: Changes in the cost per Rx due to use of more or less expensive drugs and drug strengths. Typical drivers include new products replacing old products.
Therapeutic Mix: Changes in the cost per Rx due to use of more or less expensive drugs and drug strengths. Typical drivers include new products replacing old products.
17 2007 Express Scripts, Inc. All Rights Reserved.
Component 2001:02
2002:03
2003:04
2004:05
2005:06
Price 7.5% 6.6% 6.0% 5.3% 4.3%
Units per Rx -0.1% 0.3% 0.2% 0.1% 0.4%
Brand/Generic Mix -2.3% -2.6% -2.6% -2.7% -2.9%
Therapeutic Mix 5.3% 2.6% 3.7% 0.8% 1.7%
= Cost per Rx
X Utilization
= Common Drugs
+ New Drugs
Overall Rx Trend
Components of Rx Cost Trend*
* Excluding Specialty starting in 2003
18 2007 Express Scripts, Inc. All Rights Reserved.
Component 2001:02
2002:03
2003:04
2004:05
2005:06
Price 7.5% 6.6% 6.0% 5.3% 4.3%
Units per Rx -0.1% 0.3% 0.2% 0.1% 0.4%
Brand/Generic Mix -2.3% -2.6% -2.6% -2.7% -2.9%
Therapeutic Mix 5.3% 2.6% 3.7% 0.8% 1.7%
= Cost per Rx
X Utilization
= Common Drugs
+ New Drugs
Overall Rx Trend
Components of Rx Cost Trend*
* Excluding Specialty starting in 2003
19 2007 Express Scripts, Inc. All Rights Reserved.
Top Therapeutic Mix Changes
-6% -4% -2% 0% 2% 4% 6% 8%
AnticonvulsantsAnticonvulsants• LyricaLyrica®® 6.9%6.9%
AntiviralsAntivirals• AtriplaAtripla®® 4.3%4.3%
Beta BlockersBeta Blockers• Coreg CR Coreg CR TMTM, Toprol XL, Toprol XL®® 3.3%3.3%
DermatologicsDermatologics•ElidelElidel®®-2.4%-2.4% •ProtopicProtopic®®
NSAIDsNSAIDs•COX-IIsCOX-IIs
-4.6%-4.6%
Ranked by Percent Change
20 2007 Express Scripts, Inc. All Rights Reserved.
Component 2001:02
2002:03
2003:04
2004:05
2005:06
Price 7.5% 6.6% 6.0% 5.3% 4.3%
Units per Rx -0.1% 0.3% 0.2% 0.1% 0.4%
Brand/Generic Mix -2.3% -2.6% -2.6% -2.7% -2.9%
Therapeutic Mix 5.3% 2.6% 3.7% 0.8% 1.7%
= Cost per Rx 10.5% 6.8% 7.2% 3.3% 3.5%
X Utilization
= Common Drugs
+ New Drugs
Overall Rx Trend
Components of Rx Cost Trend*
* Excluding Specialty starting in 2003
21 2007 Express Scripts, Inc. All Rights Reserved.
Component 2001:02
2002:03
2003:04
2004:05
2005:06
Price 7.5% 6.6% 6.0% 5.3% 4.3%
Units per Rx -0.1% 0.3% 0.2% 0.1% 0.4%
Brand/Generic Mix -2.3% -2.6% -2.6% -2.7% -2.9%
Therapeutic Mix 5.3% 2.6% 3.7% 0.8% 1.7%
= Cost per Rx 10.5% 6.8% 7.2% 3.3% 3.5%
X Utilization 6.3% 6.8% 2.9% 4.0% 2.2%
= Common Drugs
+ New Drugs
Overall Rx Trend
Components of Rx Cost Trend*
* Excluding Specialty starting in 2003
22 2007 Express Scripts, Inc. All Rights Reserved.
Component 2001:02
2002:03
2003:04
2004:05
2005:06
Price 7.5% 6.6% 6.0% 5.3% 4.3%
Units per Rx -0.1% 0.3% 0.2% 0.1% 0.4%
Brand/Generic Mix -2.3% -2.6% -2.6% -2.7% -2.9%
Therapeutic Mix 5.3% 2.6% 3.7% 0.8% 1.7%
= Cost per Rx 10.5% 6.8% 7.2% 3.3% 3.5%
X Utilization 6.3% 6.8% 2.9% 4.0% 2.2%
= Common Drugs
+ New Drugs
Overall Rx Trend
Components of Rx Cost Trend*
* Excluding Specialty starting in 2003
23 2007 Express Scripts, Inc. All Rights Reserved.
Utilization
Prevalence
• Proportion of members utilizing drugs
• Impacted by diagnosis and therapy plan
2006 Prevalence Trend: 1%
Intensity
• Number of Rxs filled among utilizers
• Impacted by length of therapy
2006 Intensity Trend: 1.2%
24 2007 Express Scripts, Inc. All Rights Reserved.
Lowest Utilization Increase in 5 Years
-5%
0%
5%
10%
15%
20%
Antivirals Macrolides Quinolones Hypnotics Depression
2005 2006
% C
han
ge in
U
tiliza
tion
25 2007 Express Scripts, Inc. All Rights Reserved.
Component 2001:02
2002:03
2003:04
2004:05
2005:06
Price 7.5% 6.6% 6.0% 5.3% 4.3%
Units per Rx -0.1% 0.3% 0.2% 0.1% 0.4%
Brand/Generic Mix -2.3% -2.6% -2.6% -2.7% -2.9%
Therapeutic Mix 5.3% 2.6% 3.7% 0.8% 1.7%
= Cost per Rx 10.5% 6.8% 7.2% 3.3% 3.5%
X Utilization 6.3% 6.8% 2.9% 4.0% 2.2%
= Common Drugs 17.5% 14.0% 10.4% 7.5% 5.8%
+ New Drugs
Overall Rx Trend
Components of Rx Cost Trend*
* Excluding Specialty starting in 2003
26 2007 Express Scripts, Inc. All Rights Reserved.
Component 2001:02
2002:03
2003:04
2004:05
2005:06
Price 7.5% 6.6% 6.0% 5.3% 4.3%
Units per Rx -0.1% 0.3% 0.2% 0.1% 0.4%
Brand/Generic Mix -2.3% -2.6% -2.6% -2.7% -2.9%
Therapeutic Mix 5.3% 2.6% 3.7% 0.8% 1.7%
= Cost per Rx 10.5% 6.8% 7.2% 3.3% 3.5%
X Utilization 6.3% 6.8% 2.9% 4.0% 2.2%
= Common Drugs 17.5% 14.0% 10.4% 7.5% 5.8%
+ New Drugs 1.0% 0.5% 0.3% 0.4% 0.2%
Overall Rx Trend
Components of Rx Cost Trend*
* Excluding Specialty starting in 2003
27 2007 Express Scripts, Inc. All Rights Reserved.
Component 2001:02
2002:03
2003:04
2004:05
2005:06
Price 7.5% 6.6% 6.0% 5.3% 4.3%
Units per Rx -0.1% 0.3% 0.2% 0.1% 0.4%
Brand/Generic Mix -2.3% -2.6% -2.6% -2.7% -2.9%
Therapeutic Mix 5.3% 2.6% 3.7% 0.8% 1.7%
= Cost per Rx 10.5% 6.8% 7.2% 3.3% 3.5%
X Utilization 6.3% 6.8% 2.9% 4.0% 2.2%
= Common Drugs 17.5% 14.0% 10.4% 7.5% 5.8%
+ New Drugs 1.0% 0.5% 0.3% 0.4% 0.2%
Overall Rx Trend
Components of Rx Cost Trend*
* Excluding Specialty starting in 2003
28 2007 Express Scripts, Inc. All Rights Reserved.
~Three-fold Drop in New DrugsCompared to 1996
Nature Reviews Drug Discovery 6, 99-101 (February 2007)
0
10
20
30
40
50
60
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
New Molecular Entities
29 2007 Express Scripts, Inc. All Rights Reserved.
Component 2001:02
2002:03
2003:04
2004:05
2005:06
Price 7.5% 6.6% 6.0% 5.3% 4.3%
Units per Rx -0.1% 0.3% 0.2% 0.1% 0.4%
Brand/Generic Mix -2.3% -2.6% -2.6% -2.7% -2.9%
Therapeutic Mix 5.3% 2.6% 3.7% 0.8% 1.7%
= Cost per Rx 10.5% 6.8% 7.2% 3.3% 3.5%
X Utilization 6.3% 6.8% 2.9% 4.0% 2.2%
= Common Drugs 17.5% 14.0% 10.4% 7.5% 5.8%
+ New Drugs 1.0% 0.5% 0.3% 0.4% 0.2%
Overall Rx Trend
Components of Rx Cost Trend*
* Excluding Specialty starting in 2003
30 2007 Express Scripts, Inc. All Rights Reserved.
Component 2001:02
2002:03
2003:04
2004:05
2005:06
Price 7.5% 6.6% 6.0% 5.3% 4.3%
Units per Rx -0.1% 0.3% 0.2% 0.1% 0.4%
Brand/Generic Mix -2.3% -2.6% -2.6% -2.7% -2.9%
Therapeutic Mix 5.3% 2.6% 3.7% 0.8% 1.7%
= Cost per Rx 10.5% 6.8% 7.2% 3.3% 3.5%
X Utilization 6.3% 6.8% 2.9% 4.0% 2.2%
= Common Drugs 17.5% 14.0% 10.4% 7.5% 5.8%
+ New Drugs 1.0% 0.5% 0.3% 0.4% 0.2%
Overall Rx Trend 18.5% 14.5% 10.6% 7.9% 5.9%
Components of Rx Cost Trend*
* Excluding Specialty starting in 2003
?
31 2007 Express Scripts, Inc. All Rights Reserved.
12.9%
16.1% 16.8%
17.4%16.2%
16.7%
18.5%
14.5%
10.6% 7.9%
5.9%
0%
5%
10%
15%
20%
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Lowest Drug Trend In a Decade
Express Scripts Internal Data, 2006
Note: Specialty tracked separately as of 2003
Dru
g T
rend
32 2007 Express Scripts, Inc. All Rights Reserved.
12.9%
16.1% 16.8%
17.4%16.2%
16.7%
18.5%
14.5%
10.6% 7.9%
5.9%
0%
5%
10%
15%
20%
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Lowest Drug Trend In a Decade
Express Scripts Internal Data, 2006
Note: Specialty tracked separately as of 2003
80%
60%
40%
20%
0%
Generic F
ill RateD
rug
Tre
nd
33 2007 Express Scripts, Inc. All Rights Reserved.
Forecasted Single Digit Trends Through 2010
Projected non-specialty trends for ESI commercial plan sponsors. 2005-6 actual, 2007-10 estimated
0%
2%
4%
6%
8%
10%
2005 2006 2007 2008 2009 2010Rxs Cost
7.9% 5.9% 7.5% 8.5% 9.1% 7.5%
34 2007 Express Scripts, Inc. All Rights Reserved.
Brand Drugs Going Generic Soon
More than $50 billion within the next five years
An
nua
l Sa
les
$ B
illio
n
2007 2008 2009 2010 20110
3
6
9
12
15$11.2$11.2 $10.2$10.2 $8.6$8.6 $12.8$12.8 $8.5$8.5
35 2007 Express Scripts, Inc. All Rights Reserved.
Brand Drugs Going Generic Soon
More than $50 billion within the next five years
0
3
6
9
12
15
An
nua
l Sa
les
$ B
illio
n
ZyrtecZyrtecWellbutrin XLWellbutrin XL
ImitrexImitrex
AmbienAmbien
NorvascNorvasc
OtherOther
LamictalLamictalRisperdalRisperdal
FosamaxFosamax
Effexor XREffexor XR
Advair*Advair*
OtherOther
ValtrexValtrex
TopamaxTopamax
PrevacidPrevacid
OtherOther
CozaarCozaar
LipitorLipitor
OtherOther
LevaquinLevaquin
ZyprexaZyprexa
ActosActos
ProtonixProtonix
OtherOtherToprol XLToprol XL
Adderall XRAdderall XR
2007 2008 2009 2010 2011
$11.2$11.2 $10.2$10.2 $8.6$8.6 $12.8$12.8 $8.5$8.5
36 2007 Express Scripts, Inc. All Rights Reserved.
Top Five Therapy ClassesOverall Total Ingredient Costs, 2005:2006 PMPY
$0
$20
$40
$60
$80
$100
Lipids GI Depression Diabetes Asthma
2005 2006
PM
PY
3.6%3.6% 6.7%6.7% 7.1%7.1% 15.5%15.5% 11.6%11.6%
37 2007 Express Scripts, Inc. All Rights Reserved.
0%
5%
10%
15%
20%
25%
30%
Generic Antidepressant Market Share Gaps
Jan 2001 Jan 2002 Jan 2003 Jan 2004 Jan 2005 Jan 2006
citalopram actual
paroxetine actual
fluoxetine actual
Without action, our Without action, our SSRI generic use fell SSRI generic use fell short by about short by about 30%30%
Without action, our Without action, our SSRI generic use fell SSRI generic use fell short by about short by about 30%30%
fluoxetine ideal
paroxetine ideal
citalopram ideal
38 2007 Express Scripts, Inc. All Rights Reserved.
0%
5%
10%
15%
20%
25%
30%
Generic Antidepressant Market Share Gaps
Jan 2001 Jan 2002 Jan 2003 Jan 2004 Jan 2005 Jan 2006
We didn’t want the same We didn’t want the same thing to happen in the thing to happen in the biggest class -- Lipidsbiggest class -- Lipids
We didn’t want the same We didn’t want the same thing to happen in the thing to happen in the biggest class -- Lipidsbiggest class -- Lipids
citalopram actual
paroxetine actual
fluoxetine actual
fluoxetine ideal
paroxetine ideal
citalopram ideal
2006A Large Opportunity for
Savings In the Statin Class
40 2007 Express Scripts, Inc. All Rights Reserved.
Statin Market Shares
Q1-2 2005 Q3-4 2005 Q1-2 2006 Q3-4 2006
70%
60%
50%
40%
30%
20%
10%
0% ZocorZocor
Zocor gained market share prior to patent expirationZocor gained market share prior to patent expiration
41 2007 Express Scripts, Inc. All Rights Reserved.
Statin Market Shares
Q1-2 2005 Q3-4 2005 Q1-2 2006 Q3-4 2006
70%
60%
50%
40%
30%
20%
10%
0% ZocorZocor
SimvastatinSimvastatin
Simvastatin continued on Zocor’s market growth curveSimvastatin continued on Zocor’s market growth curve
42 2007 Express Scripts, Inc. All Rights Reserved.
Statin Market Shares
Q1-2 2005 Q3-4 2005 Q1-2 2006 Q3-4 2006
70%
60%
50%
40%
30%
20%
10%
0% ZocorZocor
SimvastatinSimvastatin
Generic HMGsGeneric HMGs
Generic drugs now lead the statin market.Generic drugs now lead the statin market.
43 2007 Express Scripts, Inc. All Rights Reserved.
Express Scripts Outperformed The Nation
Q1-2 2005 Q3-4 2005 Q1-2 2006 Q3-4 2006
70%
60%
50%
40%
30%
20%
10%
0%
ESI Generic ESI Generic HMGsHMGs
NMS Generic NMS Generic HMGsHMGs
44 2007 Express Scripts, Inc. All Rights Reserved.
Statin Trend
Without GenericsToda
y
With GenericsToda
y
-2% -1% 0% 1% 2% 3%
45 2007 Express Scripts, Inc. All Rights Reserved.
Statin Trend
Without GenericsToda
y
With GenericsToda
y
-2% -1% 0% 1% 2% 3%
+2.0%+2.0%
46 2007 Express Scripts, Inc. All Rights Reserved.
Statin Trend
Without GenericsToda
y
With GenericsToda
y
-2% -1% 0% 1% 2% 3%
-1.1%-1.1%
+2.0%+2.0%
47 2007 Express Scripts, Inc. All Rights Reserved.
Therapy Class #1: Lipids Generic Drugs Drove Down Trend
Class Trend: 3.6%
5.5%
0.0%
3.9%
1.3%
-1.1%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand/Generic Mix
Price
-5.6%
48 2007 Express Scripts, Inc. All Rights Reserved.
Therapy Class #1: Lipids Generic Drugs Drove Down Trend
Class Trend: 3.6%
5.5%
0.0%
3.9%
1.3%
-1.1%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand/Generic Mix
Price
-5.6%
49 2007 Express Scripts, Inc. All Rights Reserved.
Tremendous Generic OpportunityClass Trend: 6.7%
1.8%
-1.3%
2.1%
2.8%
0.0%
0.0%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand/Generic Mix
Price
Therapy Class #2: Gastrointestinals
50 2007 Express Scripts, Inc. All Rights Reserved.
Tremendous Generic OpportunityClass Trend: 6.7%
1.8%
-1.3%
2.1%
2.8%
0.0%
0.0%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand/Generic Mix
Price
Therapy Class #2: Gastrointestinals
??
51 2007 Express Scripts, Inc. All Rights Reserved.
Step Therapy Can Drive PPI Savings
PPI GFR Ingredient PMPY
Without PPI Step With PPI Step
$44$44
$63$63
3838%%
1414%%
52 2007 Express Scripts, Inc. All Rights Reserved.
Prevalence Drove Antidepressants
Class Trend: 7.1%
1.9%
1.7%
1.3%
4.2%
0.0%
-2.5%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand/Generic Mix
Price
Therapy Class #3: Antidepressants
53 2007 Express Scripts, Inc. All Rights Reserved.
Prevalence Drove Antidepressants
Class Trend: 7.1%
1.9%
1.7%
1.3%
4.2%
0.0%
-2.5%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand/Generic Mix
Price
Therapy Class #3: Antidepressants
54 2007 Express Scripts, Inc. All Rights Reserved.
Trend Driven By Prevalence
Class Trend: 15.5%
5.2%
2.9%
0.7%
5.4%
1.4%
-1.8%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand/Generic Mix
Price
Therapy Class #4: Diabetes
55 2007 Express Scripts, Inc. All Rights Reserved.
Trend Driven By Prevalence
Class Trend: 15.5%
5.2%
2.9%
0.7%
5.4%
1.4%
-1.8%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand/Generic Mix
Price
Therapy Class #4: Diabetes
56 2007 Express Scripts, Inc. All Rights Reserved.
Price Drove AsthmaClass Trend: 11.6%
8.2%
0.8%
1.6%
0.7%
0.0%
0.0%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand/Generic Mix
Price
Therapy Class #5: Asthma
57 2007 Express Scripts, Inc. All Rights Reserved.
Price Drove AsthmaClass Trend: 11.6%
8.2%
0.8%
1.6%
0.7%
0.0%
0.0%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand/Generic Mix
Price
Therapy Class #5: Asthma
58 2007 Express Scripts, Inc. All Rights Reserved.
Hypnotics Are Growing QuicklyClass Trend: 36.9%
13.8%
3.1%
5.3%
10.6%
0.0%
-0.1%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand/Generic Mix
Price
Therapy Class #19: Hypnotics
59 2007 Express Scripts, Inc. All Rights Reserved.
Hypnotics Are Growing QuicklyClass Trend: 36.9%
13.8%
3.1%
5.3%
10.6%
0.0%
-0.1%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand/Generic Mix
Price
Therapy Class #19: Hypnotics
60 2007 Express Scripts, Inc. All Rights Reserved.
Hypnotics Are Growing QuicklyClass Trend: 36.9%
13.8%
3.1%
5.3%
10.6%
0.0%
-0.1%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand/Generic Mix
Price
Therapy Class #19: Hypnotics
61 2007 Express Scripts, Inc. All Rights Reserved.
Hypnotics Are Growing QuicklyClass Trend: 36.9%
13.8%
3.1%
5.3%
10.6%
0.0%
-0.1%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand/Generic Mix
Price
Therapy Class #19: Hypnotics
62 2007 Express Scripts, Inc. All Rights Reserved.
63 2007 Express Scripts, Inc. All Rights Reserved.
64 2007 Express Scripts, Inc. All Rights Reserved.
Hypnotics Need Your Focus
2002 2003 2004 2005 2006
80%
70%
60%
50%
40%
30%
20%
10%
0%
AmbienAmbien
Ambien Ambien CRCRLunestaLunesta
SonataSonata
RozeremRozerem
65 2007 Express Scripts, Inc. All Rights Reserved.
Adding Programs Drives Savings
0%
5%
10%
Without GT With GT
>2 new programs
1 new program
No new programs
ESI 2006 Non-Specialty ESI 2006 Non-Specialty Trend: 5.9%Trend: 5.9%
66 2007 Express Scripts, Inc. All Rights Reserved.
Adding Programs Drives Savings
10.0%9.6%
0%
5%
10%
Without GT With GT
>2 new programs
1 new program
No new programs
67 2007 Express Scripts, Inc. All Rights Reserved.
Adding Programs Drives Savings
7.2%
10.0%
5.5%
9.6%
0%
5%
10%
Without GT With GT
>2 new programs
1 new program
No new programs
68 2007 Express Scripts, Inc. All Rights Reserved.
Adding Programs Drives Savings
3.0%
7.2%
10.0%
5.5%
9.6%
1.8%
0%
5%
10%
Without GT With GT
>2 new programs
1 new program
No new programs
69 2007 Express Scripts, Inc. All Rights Reserved.
2006 Trend At An Encouraging 5.9%
• The more you manage, the lower your trend.
• Opportunities abound for managing out waste.
– PPI class represents a significant opportunity
– Don’t be asleep with Hypnotics spend
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