The three most expensive drug categories, on a per-member/per-year basis for the PBM's clients, increased by 19% or more in 2016, and similar growth is expected in the next three years. Per-patient spending on HCV drugs, however, declined by 34% last year.

Pricing drugs differently by indication presents an opportunity to better align the cost of medicines to value in certain cases, but the regulatory, policy and administrative challenges are daunting. Experts debated the challenges and opportunities during the ISPOR annual meeting.

Express Scripts and CVS/Caremark, two US pharmacy benefit managers (PBMs) that have been increasingly vocal about high drug prices, have revised their formularies for 2016 and cut dozens of brand-name therapies from the lists of pharmaceutical products that they will cover on behalf of their health plan clients.