SUMMER  2001 
Volume 6 / Number 3

New Drugs in the 21st Century

Raulo S. Frear, Pharm.D., Vice President, Clinical Services, Express Scripts

Dr. Raulo Frear, the Vice President of Clinical Services for Express Scripts focused attention on drugs that are in the approval pipeline. He emphasized that most of the drugs currently in late-stage trials are similar to current products. In many cases, the new drugs are the result of manufacturers working to preserve an existing drug franchise rather than representing true innovation. This means the new drug is essentially a variation of an existing molecule.

Despite the low number of innovative drugs in the approval pipeline, drug costs are expected to continue to increase due to increased utilization by the senior population and the fact that the drugs approved in the last three to four years are expected to continue to increase in use (e.g., Zyprexa®, Evista®, Celexa®). Frear described how, in its first year, a new drug generally has a small impact on drug spend, but over time builds name recognition among patients and doctors and can have a significant financial impact on plans.

Another source of new drugs and increased drug spend is the biotechnology industry. Frear expects spending on Enbrel®, currently at $4 to 5 billion per year, to double in the next few years. Other biotech drugs to keep an eye on include Xolair® for asthma, Zovant® for sepsis (mainly a hospital drug) and Aranesp® for anemia. The Human Genome Project is also expected to have a large impact on drug discovery, but not until 2005 to 2010.

According to Frear, the bottom line is plan sponsors and their PBMs should concentrate their efforts on the top six drug classes: respiratory, gastrointestinal, central nervous system, anti-viral, cardiovascular, and diabetes. He recommends being familiar with the pipeline drugs and planning ahead with your PBM to plan how or whether they will be covered.

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