Oscar Santalo, PharmD, MBA, MHA, BCPS
Pharmacy Operations and Compliance Coordinator

Episode 4 Description: In this episode of Pharm So Hard, Oscar Santalo PharmD, MBA, MHA, BCPS with his learner Darla Quevedo PharmD 2021 candidate from the University of Florida School Of Pharmacy discuss drug trends for 2019 – 2020.  Here they discuss the Top 25 drugs by expenditures in nonfederal hospitals in 2018, the rise of biosimilars & specialty drugs, and medications coming off of patent.  

  • Introduction
    • Overall pharmaceutical expenditures in the United States grew 5.5% in 2018, compared to 2017, for a total of $476.2 billion
    • Nonfederal hospitals accounted for $35.8 billion in prescription expenditures in 2018, a 4.8%
  • What is the importance/relevance of this topic to pharmacy administration and pharmacy practice overall?
    • Factors driving growth: (1) purchases of new products that were not available previously, (2) price changes of existing agents, including both brand and generic drugs, and (3) changes in the volume of purchases (reflecting changes in utilization)
    • High growth in expenditures for older generics: (1) drug shortages leading to demand-related price increases or shifts in utilization to the branded products, (2) product discontinuations due to either manufacturing issues or business decisions
  • Major Endpoints
    • 59 NMEs and 7 biosimilars approved in 2018
    • Specialty drug expenditures increased by 11.1% in 2018 compared to 2017, a rate is faster than the overall market growth rate of 5.5%.
    • Among the top 25 categories with the greatest increases in expenditures in 2018 compared to 2017 were drugs for neurologic disorders (32.4%), immunologic agents (18.0%), contraceptives (17.7%), and hormones (12.5%)
    • Hospitals/clinics must also be aware of drugs that have potential patent expiration each year. Generic forms of these drugs may be in the pipeline which are cheaper alternatives to their brand counterparts


  1. Schumock GT, Stubbings J, Hoffman JM, et al. National trends in prescription drug expenditures and projections for 2019. Am J Health-Syst Pharm. 2019; 76:1105–1121

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