Which diseases are driving drug spending hikes? It's not just hep C

Industry watchers well know that U.S. drug spending is rising--a lot. And they also know that it's likely to continue over the next few years if some major changes don't occur. But which medical conditions will be responsible for the swelling tide? Some of those may surprise you.

Using the expected increase in cost per dose and the rates of use for drugs,Quartz has compiled a list of the maladies with the fastest expected growth in spending per patient over the next three years. Topping the chart is hepatitis C, with an estimated 166% three-year increase. That won't surprise those who read Express Scripts' ($ESRX) drug spending report earlier this month, which said new treatments from Gilead ($GILD) and AbbVie ($ABV) took hep C spending up by 742.6% last year.

Second place on Quartz's list, though, may raise a few eyebrows. Per-patient spending on the rare genetic blood disorder hereditary angioedema (HAE) will increase by 67.4% over the measured period, despite the fact that it only affects one in 18,000 people in the U.S.

As pharma knows, though, rare-disease drugs often come with high price tags--like Shire's ($SHPG) HAE med Cinryze, which made FiercePharma's most recent list of the top 10 most expensive drugs. Its $230,826 per U.S. patient per year price tag ranked it at No. 4, behind fellow rare-disease treatments Soliris from Alexion ($ALXN), Naglazyme from BioMarin ($BMRN), and Kalydeco from Vertex ($VRTX).

And before acquiring Cinryze--which it did with 2013's ViroPharma buyout--Shire already had another HAE drug in its own brand stable. That med, Firazyr, treats acute attacks of swelling in HAE patients, making it a complementary product to Cinryze, which is used to prevent them. CSL Behring, Dyax and Salix Pharmaceuticals--which recently agreed to be acquired by Valeant ($VRX)--also make products for the disease.

Also appearing on Quartz list are inflammatory conditions at No. 3--sure to be propelled by new psoriasis med Cosentyx from Novartis ($NVS) and the onslaught of Big Pharma pipeline rivals set to follow--cancer at No. 4, and diabetes at No. 5. Further down the list, the conditions include pulmonary arterial hypertension, a disease Bayer has tagged for growth with new therapy Adempas.

ome payers, though, have other plans. Express Scripts, for one, has rallied against skyrocketing hep C prices by negotiating an exclusive deal with AbbVie and touching off a pricing war. CMO Steve Miller says he plans to apply the same strategy to combat rising costs in fields like cancer.

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