Immunomodulators - All Data 2

Medicare Part D
Approval Year for

Rx Name Indications Dermatologic Percent Change from Average Annual
Average Annual 2012 to 2018* Spending Growth
Utilization Spending
(Net Change) Rate
RA, JIA, PsA, AS, CD, Pediatric CD, UC, 354.2% (+

Adalimumab PsO, HS 2008 $ 1,776,053,281 $2,389,261,318) 29.0%
Etanercept RA, JIA, PsA, AS, PsO 2004 $ 1,360,142,382 163.7% (+ 17.9%
$1,182,658,703)
Ustekinumab PsO, PsA, CD 2009 $ 250,889,769 1057.0% (+ 51.6%

$532,323,714)
1496.7% (+
Secukinumab** PsO, PsA, AS 2015 $ 180,213,225 $346,825,826) 178.8%
Apremilast** PsA; Psoriasis; Oral Ulcers associated 2014 $ 162,414,103 2565.3% (+ 182.0%
with Behcet's Disease $306,332,010)
Certolizumab PsO, CD, RA, PsA, AS 2018 $ 123,508,620 193.2% (+ 20.7%

PEGol $108,460,380)
797.7% (+
Ixekizumab** PsO, PsA, AS 2016 $ 72,013,541 236.0%
$115,982,838)
282.0% (+
Dupilumab** AD 2017 $ 64,226,884 $75,152,308) 282.0%
Infliximab CD, Pediatric CD, UC, Pediatric UC, 2006 $ 61,085,564 198.6% (+ 20.4%
RA, AS, PsA, PsO $61,160,195)
717.7% (+
Guselkumab** PsO 2017 $ 43,241,292 $67,633,949) 717.7%
RA, PV, Non-Hodgkin's Lymphoma,

Chronic Lymphocytic Leukemia, 148.0% (+
Rituximab 1997 $ 39,447,293 16.7%
Granulomatosis with Polyangiitis, $32,861,032)
Microscopic Polyangiitis
Anakinra RA; CAPS $ 8,289,419 207.3% (+$8,902,828) 112.3%
2448.6% (+
Brodalumab** PsO 2017 $ 1,629,224 $3,012,395) 2448.6%
Medicare Part D
Approval Year for
Rx Name Indications Dermatologic Average Annual Percent Change from Average Annual
Spending per 2012 to 2018* Spending per
Utilization Dosage Unit Growth
Dosage Unit (Net Change)
Rate
Ustekinumab PsO, PsA, CD 2009 $ 16,075 73.9% (+$8,738) 9.7%

Guselkumab** PsO 2017 $ 10,013 5.1% (+$493) 5.1%
Ixekizumab** PsO, PsA, AS 2016 $ 4,789 20.3% (+$882) 9.7%
Secukinumab** PsO, PsA, AS 2015 $ 3,165 31.0% (+$849) 9.4%
Certolizumab $ 3,114 89.3% (+$1,938) 11.3%
PEGol PsO, CD, RA, PsA, AS 2018
RA, JIA, PsA, AS, CD, Pediatric CD, UC, $ 1,683 142.1% (+$1,445) 16.0%
Adalimumab PsO, HS 2008
Brodalumab** PsO 2017 $ 1,191 0.31% (+$4) 0.3%
Etanercept RA, JIA, PsA, AS, PsO 2004 $ 830 154.4% (+$746) 16.9%
CD, Pediatric CD, UC, Pediatric UC,

Infliximab RA, AS, PsA, PsO 2006 $ 824 46.0% (+$296) 7.0%
Dupilumab** AD 2017 $ 728 2.4% (+$17) 2.4%
$ 168 110.7% (+$112) 13.7%
Anakinra RA; CAPS

Chronic Lymphocytic Leukemia,
Granulomatosis with Polyangiitis,
Rituximab Microscopic Polyangiitis 1997 $ 141 402.3% (+$260) 52.6%
PsA; Psoriasis; Oral Ulcers associated $ 43 71.9% (+$23) 14.5%

Apremilast** with Behcet's Disease 2014
Medicaid
Percent Change from

Average Annual 2012 to 2018* Average Annual
Spending Spending Growth Rate
(Net Change)
558.4% / (+
$ 936,185,436 $1,482,818,890) 38.6%
$ 448,921,765 190.4% / (+ 20.5%

$422,978,940)
$ 127,529,534 1776.5% / (+ 63.3%

$316,865,194)
1966.1% / (+
$ 89,076,632 $176,442,856) 214.8%
$ 51,165,748 5418.7% / (+ 339.6%

$92,037,865)
$ 52,561,847 188.1% / (+ 19.9%

$49,120,359)
1268.4% / (+
$ 27,530,915 342.7%
$48,627,952)
302.4% / (+
$ 37,296,261 $44,898,021) 302.4%
$ 212,841,336 149.1% / (+ 17.1%

$182,213,064)
721.9% / (+
$ 14,282,730 $22,368,185) 721.9%
112.7% / (+
$ 147,901,299 14.0%
$104,168,084)
212.7% / (+
$ 8,795,349 21.8%
$9,145,025)
$ 1,586,087 N/A N/A
176.4%
Medicaid
Average Annual Percent Change from Average Annual

Spending per 2012 to 2018* Spending per Dosage
Dosage Unit (Net Change) Unit Growth Rate
$ 14,863 47.8% (+$5,588) 7.2%

$ 9,426 -2.3% (-$216) 2.3%
$ 4,568 9.7% ($414) 4.9%
$ 2,948 48.9% (+$1,092) 15.0%
$ 2,629 63.4% (+$1,234) 9.1%
$ 1,619 124.7% (+$1,253) 14.6%
$ 1,074 N/A N/A

$ 782 124.0% (+$604) 14.5%
$ 688 12.0% (+$74) 2.3%

$ 680 -8.0% (-$57) -8.0%
$ 163 97.4% (+$96) 12.6%
$ 70 34.9% (+$21) 5.3%
$ 41 54.6% (+$17) 11.8%

Total Medicare Part D vs. Medicaid Spending for Immuno
500M
400M
Total Spending (USD)
300M
200M
200M
100M
K
1
Year
Spending for Immunomodulators (2012-2018)
$4,000
$3,500
$3,000
$2,500
Avg. Spending Per Dosage Unit (USD)
$2,000
$1,500
$1,000
Avg.
$1,500
$1,000
$500
$0
1
Year
Avg Medicare Part D vs. Medicaid Spending Per Dosage Unit for Immunomodulato
$4,000
$3,500
$3,000
$2,500
$2,000
$1,500
$1,000
Avg.
$1,500
$1,000
$500
$0
1
Year
nit for Immunomodulators (2012-2018)
Avg Medicare Part
$20,000
$15,000
. Spending Per Dosage Unit (USD)
$10,000
Avg. Spending Per Dosage Unit
$5,000
$10,000
$0
1
M e a n in A v e r a g e S p e n d in g P e r D o s a g e U n it (U S D )
Mean and Annual Growth Rate for Average Medicare Part D and M
Spending Per Dosage Unit
1.2
0.8
0.6
0.4
0.2
0
1
M ean Total Spending (USD)
Mean and Annual Growth Rate in Total Medicare Part D and Medicaid Spe
1.2
1
0.8
0.6
0.4
0.2
0
1
Avg Medicare Part D vs. Medicaid Spending Per Dosage Unit for Immunomodulators (2012-2018)
Year
Percent Change Each Year in Average Medicare Part D Spending Per Dosage Unit for Immunom
1.2
0.8
0.6
A n n u a l G r o w th R a te in A v e r a g e S p e n d in g P e r D o s a g e U n it
0.4
0.2
0
1
age Medicare Part D and Medicaid
1.2
0.8
0.6
0.4
0.2
Percent chage in Total Medicare Part D Spending for the Imm

1.2
0.8
0.6
0.4
Percent chage in Total Medicare Part D Spending for the Imm
1.2
0.8
0.6
0.4
0.2
0
1
A nnual Growth Rate in Total Spending
re Part D and Medicaid Spending Percent Change in Total Medicare Part D and Medicaid S
1.2
1 1.2
0.8
0.6 1
0.4
0.2
0 0.8
Axis Title
0.6
0.4
0.2
0
1
odulators (2012-2018)
r Dosage Unit for Immunomodulators (2012-2018)
1.2
0.8
0.6
0.4
0.2
Average0Medicare
1 Part D vs. Medicaid Spe
$6,000.00
art D Spending for the Immunomodulators

$5,000.00
$4,000.00
xis Title
$3,000.00
art D Spending for the Immunomodulators
$5,000.00
$4,000.00
Axis Title
$3,000.00
$2,000.00
$1,000.00
care Part D and Medicaid Spending for Immunomodulators (2012-2018) $0.00

2012 2013 2014 2
Chart Title
are Part D vs. Medicaid Spending for Immunomodulators Per Dosage Unit (2012-2018)
Adalimumab Medicare D
Anakinra Medicare D
Apremilast Medicare D
Brodalumab Medicare D
Certolizumab Medicare D
Etanercept Medicare D
Infliximab Medicare D
Ixekizumab Medicare D
Rituximab Medicare D
Secukinumab Medicare D
Adalimumab Medicaid
Anakinra Medicaid
Anakinra Medicare D
Adalimumab Medicaid
Anakinra Medicaid
Apremilast Medicaid
Certolizumab Medicaid
Etanercept Medicaid
Infliximab Medicaid
Ixekizumab Medicaid
Rituximab Medicaid
Secukinumab Medicaid
2013 2014 2015 2016 2017 2018

Medicare Part D
Immunomodulators 2012 2013 2014 2015
Ustekinumab $11,823.74 $13,326.35 $14,608.74 $16,212.79
Guselkumab
Ixekizumab
Certolizumab $2,169.67 $2,412.60 $2,778.18 $3,065.20
Secukinumab $2,735.60
Adalimumab $1,017.27 $1,150.67 $1,328.44 $1,616.41
Etanercept $483.05 $570.26 $658.30 $785.48
Brodalumab
Infliximab $644.13 $736.65 $829.47 $801.50
Dupilumab
Dupilumab
Rituximab $64.65 $66.23 $70.51 $74.23
Anakinra $100.86 $133.85 $157.17 $173.65
Apremilast $31.89 $36.37
Average Spending per Dos

$25,000
$20,000
$15,000
$10,000
$5,000
$0
ab ab ab ab ab ab t
ep
$10,000
$5,000
$0
ab ab ab ab ab ab t
ep
um m um m um um rc
kin elku kiz l i zu kin im an
e
te s Ixe rto cu al Et
Us Gu Ce Se Ad Br
2012 2013 2014 2015
Annual Spending Medicare Part D

Immunomodulators 2012 2013 2014 2015
Adalimumab $674,609,130 $955,331,811 $1,239,853,884 $1,662,182,181
Etanercept $722,314,079 $976,955,479 $1,198,397,788 $1,385,143,655
Ustekinumab $50,359,982 $89,501,702 $157,144,756 $205,334,691
Secukinumab $23,172,797
Apremilast $11,941,419 $75,763,881
Certolizumab $56,143,734 $76,965,425 $109,925,511 $131,546,211
Ixekizumab
Dupilumab
Infliximab $30,802,220 $42,902,833 $52,615,464 $57,784,005
Guselkumab
Rituximab $22,213,051 $30,301,487 $35,629,301 $37,829,120
Anakinra $4,294,235 $1,004,994 $8,004,714 $8,767,048
Brodalumab
Average Annual Spending for Medicare

$3,500,000,000
$3,000,000,000
$2,500,000,000
$2,000,000,000
$1,500,000,000
$1,000,000,000
$500,000,000
$0
t b
$2,000,000,000
$1,500,000,000
$1,000,000,000
$500,000,000
$0
ab pt ab ab st ab ab ab ab
rce um i la um um m
um e um li z lu xim
im an kin kin re
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tr o kiz upi fli
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u
A p Ixe D In
Ad Us S Ce
2012 2013 2014 2015 2016 2017 2018

2016 2017 2018 Immunomodulators
$17,154.78 $18,838.34 $20,561.47 Ustekinumab
$9,766.13 $10,259.39 Guselkumab
$4,357.20 $4,770.81 $5,239.52 Ixekizumab
$3,448.44 $3,819.16 $4,107.98 Secukinumab
$3,036.42 $3,301.50 $3,584.79 Certolizumab
$1,969.07 $2,237.00 $2,462.41 Adalimumab
$964.11 $1,119.38 $1,228.69 Etanercept
$1,188.66 $1,192.40 Brodalumab
$812.27 $1,005.30 $940.08 Infliximab
$719.14 $736.25 Dupilumab
$708.33 $651.61 Anakinra
$78.85 $307.18 $324.70 Rituximab
$198.65 $200.61 $212.50 Apremilast
$42.97 $49.57 $54.81
verage Spending per Dose for Medicare Part D

$25,000
$20,000
$15,000
$10,000
$5,000
ab ab ab t ab ab ab ab ab ra st
ep in la
$15,000
$10,000
$5,000
ab ab ab t ab ab ab ab ab ra st
ep kin i la
um um e rc um xim lu
m
lu
m xim a
kin im an dal fli pi pi itu An re
m
cu al Et ro I n Du Du R Ap
Se Ad B $0
Ustekinumab Guse
2012 2013 2014 2015 2016 2017 2018
re Part D
2016 2017 2018 Immunomodulators
$2,197,988,894 $2,638,536,620 $3,063,870,449 Adalimumab
$1,572,136,216 $1,761,076,674 $1,904,972,782 Etanercept
$265,156,010 $406,047,544 $582,683,697 Ustekinumab
$107,321,944 $220,359,536 $369,998,623 Infliximab
$162,941,987 $243,149,801 $318,273,429 Rituximab
$160,787,675 $164,587,669 $164,604,114 Secukinumab
$14,539,146 $70,979,492 $130,521,984 Apremilast
$26,650,730 $101,803,038 Certolizumab
$68,074,955 $83,457,058 $91,962,415 Dupilumab
$9,424,317 $77,058,267 Ixekizumab
$45,242,671 $49,841,336 $55,074,084 Guselkumab
$10,858,651 $11,899,228 $13,197,063 Anakinra
$123,026 $3,135,421 Brodalumab
nding for Medicare Part D Average Annua

$3,500,000,000
$3,000,000,000
$2,500,000,000
$2,000,000,000
$1,500,000,000
$1,000,000,000
$500,000,000
$0
b t
$2,000,000,000
$1,500,000,000
$1,000,000,000
$500,000,000
$0
ab ab ab ra ab ab t ab ab
ab ab ep
um m m xim kin m um rc um xim
kiz pi
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a lu e fli
x
u fli se itu An da al
im an kin In Ri
tu
Ixe D In R
Br
o Et st
e
Gu Ad U
2015 2016 2017 2018 2012 20

Medicaid
2012 2013 2014 2015 2016
$11,686.15 $11,532.53 $15,037.77 $15,419.79 $16,553.34
$4,265.69
$2,232.09 $2,982.04
$1,946.05 $2,241.29 $2,630.39 $2,350.75 $2,878.20
$1,004.81 $1,124.44 $1,300.00 $1,578.75 $1,910.87
$487.19 $547.69 $630.58 $751.59 $916.48
$619.79 $610.86 $684.48 $741.93 $785.30
$98.10 $127.54 $157.16 $168.52 $195.09

$58.90 $62.80 $64.81 $69.16 $70.76
$31.09 $35.77 $42.74
Average Spending per Dose for Medicaid

$25,000
$20,000
$15,000
$10,000
$5,000
$15,000
$10,000
$5,000
$0
Ustekinumab Guselkumab Ixekizumab Secukinumab Certolizumab Adalimumab Etanercept Brodalumab Infliximab Dupiluma
2012 2013 2014 2015 2016 2017 2018
Annual Spending Medicaid

2012 2013 2014 2015 2016
$265,527,470 $332,779,406 $474,282,606 $807,775,921 $1,282,754,971
$222,125,192 $255,804,308 $306,152,210 $446,809,492 $600,736,100
$17,836,115 $29,799,659 $51,719,138 $86,169,160 $143,951,167
$122,215,651 $129,283,305 $167,096,026 $211,960,092 $277,833,978
$92,411,514 $97,561,823 $116,463,000 $144,894,285 $177,010,013
$8,974,381 $49,604,737
$1,698,531 $20,792,164 $57,960,392
$26,113,373 $31,080,599 $40,191,239 $54,301,981 $68,613,182
$3,833,693
$4,299,194 $5,649,574 $6,932,750 $7,391,803 $10,981,809
Average Annual Spending for Medicaid Part D
t
b t ab ab ab ab st ab ab ab ab ra ab
ep i la kin
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an
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Ixe se ro
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Us S ec Ap Ce
D Gu B
2012 2013 2014 2015 2016 2017 2018

2017 2018
$16,533.93 $17,274.02
$9,534.27 $9,318.20
$4,759.47 $4,679.21
$3,251.66 $3,324.41
$3,177.07 $3,180.54
$2,158.38 $2,257.89
$1,046.25 $1,091.42
$1,073.68
$679.55 $694.24
$708.33 $651.61
$198.12 $193.68
$81.28 $79.47
$48.52 $48.08
e for Medicaid
Brodalumab Infliximab Dupilumab Anakinra Rituximab Apremilast
16 2017 2018
2017 2018
$1,641,831,319 $1,748,346,360
$665,720,917 $645,104,133
$228,530,191 $334,701,308
$277,071,588 $304,428,715
$210,388,858 $196,579,599
$112,310,172 $185,417,237
$81,641,258 $93,736,396
$72,398,823 $75,233,732
$14,847,251 $59,745,272
$26,297,408 $52,461,645
$3,098,638 $25,466,822
$12,868,092 $13,444,220
$1,586,087
ab
um
dal
o
Immunomodula 2012 2013 2014 2015 2016
Adalimumab
$674,609,130.28 $955,331,810.70 $1,239,853,884.21 ### ###
Medicare D
Anakinra
$4,294,235.03 $1,004,994.19 $8,004,714.44 ### ###
Medicare D
Apremilast
$11,941,418.73 ### ###
Medicare D
Brodalumab
Medicare D
Certolizumab
$56,143,733.91 $76,965,425.43 $109,925,510.93 ### ###
Medicare D
Dupilumab
Medicare D
Etanercept
$722,314,079.12 $976,955,478.64 $1,198,397,787.78 ### ###
Medicare D
Guselkumab
Medicare D
Infliximab
$30,802,219.62 $42,902,833.37 $52,615,463.95 ### ###
Medicare D
Ixekizumab
###
Medicare D
Rituximab
Medicare D $22,213,051.12 $30,301,486.67 $35,629,300.64 ### ###
Secukinumab
### ###
Medicare D
Ustekinumab
$50,359,982.47 $89,501,701.78 $157,144,756.23 ### ###
Medicare D
$1,560,736,431.55
2012 Total 2018 Total Difference

$2,311,264,940.77 $10,613,406,890.37 $8,302,141,949.60 359%
2017 2018 Immunomodula 2012
Adalimumab
### $3,063,870,449.08 $265,527,469.84
Medicaid
Anakinra
### $13,197,063.41 $4,299,194.25
Medicaid
Apremilast
### $318,273,429.22
Medicaid
Brodalumab
$123,026.25 $3,135,421.24
Medicaid
Certolizumab
### $164,604,113.84 $26,113,373.14
Medicaid
Dupilumab
### $101,803,038.04
Medicaid
Etanercept
### $1,904,972,782.22 $222,125,192.24
Medicaid
Guselkumab
### $77,058,266.88
Medicaid
Infliximab
### $91,962,414.80 $122,215,650.65
Medicaid
Ixekizumab
### $130,521,984.18
Medicaid
Rituximab
### $55,074,083.81 Medicaid 92,411,514
Secukinumab
### $369,998,622.61
Medicaid
Ustekinumab
### $582,683,696.71 $17,836,114.63
Medicaid
$6,877,155,366.04 $750,528,509.22
$5,316,418,934.49
341%
2013 2014 2015 2016 2017 2018
### ### ### ### ### $1,748,346,359.77
### ### ### ### ### $13,444,219.52
### ### ### ### $93,736,396.03
$1,586,086.65
### ### ### ### ### $75,233,732.20
### $59,745,271.66
### ### ### ### ### $645,104,132.63
### $25,466,822.44
### ### ### ### ### $304,428,715.05
### ### $52,461,644.90
### ### ### ### ### $196,579,598.56
### ### ### $185,417,236.55
### ### ### ### ### $334,701,308.37
$3,736,251,524.33
$2,985,723,015.11
398%
Immunomodula
tors 2012 2013 2014 2015
Adalimumab $1,017.27 $1,150.67 $1,328.44 $1,616.41
Medicare D
Anakinra $100.86 $133.85 $157.17 $173.65
Medicare D
Medicare D
Brodalumab
Medicare D
Certolizumab $2,169.67 $2,412.60 $2,778.18 $3,065.20
Medicare D
Dupilumab
Medicare D
Etanercept $483.05 $570.26 $658.30 $785.48
Medicare D
Guselkumab
Medicare D
Infliximab $644.13 $736.65 $829.47 $801.50
Medicare D
Ixekizumab
Medicare D
Rituximab $64.65 $66.23 $70.51 $74.23
Medicare D
Medicare D
Ustekinumab $11,823.74 $13,326.35 $14,608.74 $16,212.79
Medicare D
Adalimumab $1,004.81 $1,124.44 $1,300.00 $1,578.75

Medicaid
Anakinra $98.10 $127.54 $157.16 $168.52
Medicaid
Medicaid
Brodalumab
Medicaid
Certolizumab $1,946.05 $2,241.29 $2,630.39 $2,350.75
Medicaid
Dupilumab
Medicaid
Etanercept $487.19 $547.69 $630.58 $751.59
Medicaid
Guselkumab
Medicaid
Infliximab $619.79 $610.86 $684.48 $741.93
Medicaid
Ixekizumab
Medicaid
Rituximab $58.90 $62.80 $64.81 $69.16
Medicaid
Medicaid
Ustekinumab $11,686.15 $11,532.53 $15,037.77 $15,419.79
Medicaid
Immunomodulato 2012 2013 2014 2015
Adalimumab $674,609,130.28 $955,331,810.70 $1,239,853,884.21 $1,662,182,181.17

Medicare D
Anakinra
$4,294,235.03 $1,004,994.19 $8,004,714.44 $8,767,048.38
Medicare D
Apremilast
$11,941,418.73 $75,763,880.81
Medicare D
Brodalumab
Medicare D
Certolizumab
$56,143,733.91 $76,965,425.43 $109,925,510.93 $131,546,210.96
Medicare D
Dupilumab
Medicare D
Etanercept
$722,314,079.12 $976,955,478.64 $1,198,397,787.78 $1,385,143,654.66
Medicare D
Guselkumab
Medicare D
Infliximab
$30,802,219.62 $42,902,833.37 $52,615,463.95 $57,784,005.32
Medicare D
Ixekizumab
Medicare D
Rituximab
$22,213,051.12 $30,301,486.67 $35,629,300.64 $37,829,119.78
Medicare D
Secukinumab
$23,172,796.51
Medicare D
Ustekinumab
$50,359,982.47 $89,501,701.78 $157,144,756.23 $205,334,690.66
Medicare D
Adalimumab
Medicaid $265,527,469.84 $332,779,406.13 $474,282,605.92 $807,775,920.89
Anakinra
$4,299,194.25 $5,649,574.47 $6,932,749.83 $7,391,803.01
Medicaid
Apremilast
$1,698,531.04 $20,792,163.75
Medicaid
Brodalumab
Medicaid
Certolizumab
$26,113,373.14 $31,080,599.40 $40,191,238.86 $54,301,981.40
Medicaid
Dupilumab
Medicaid
Etanercept
$222,125,192.24 $255,804,307.86 $306,152,210.01 $446,809,492.15
Medicaid
Guselkumab
Medicaid
Infliximab
$122,215,650.65 $129,283,305.35 $167,096,025.71 $211,960,092.05
Medicaid
Ixekizumab
Medicaid
Rituximab
92,411,514 $97,561,822.54 $116,462,999.88 $144,894,284.51
Medicaid
Secukinumab
$8,974,380.99
Medicaid
Ustekinumab
$17,836,114.63 $29,799,659.34 $51,719,138.20 $86,169,160.40
Medicaid
Total Medicare Part D vs. Medicaid Spend
3000M
2500M
2000M
1500M
1000M
500M
500M
K
2012 2013 2014
Adalimumab Medicare D Adalimumab Medicaid Anakin

Apremilast Medicaid Brodalumab Medicare D Certol
Dupilumab Medicaid Etanercept Medicare D Etane
Infliximab Medicare D Infliximab Medicaid Ixekizu
Rituximab Medicaid Secukinumab Medicare D Secuk
Avg Total Spending Total Spending Over

Rx Name 2012-18 (Medicare Avg Total Spending All Years: Medicare
2012-18 (Medicaid)
D) D/Medicaid
$12,432,372,969.53 /
$ 1,776,053,281.36 $ 936,185,436.05
Adalimumab $6,553,298,052.37
$58,025,934.00 /
$ 8,289,419.14 $ 8,795,348.94
Anakinra $61,567,442.60
$812,070,516.60 /
$ 162,414,103.32 $ 51,165,748.09
Apremilast** $255,828,740.45
$3,258,447.49 /
$ 1,629,223.75 $ 1,586,086.65
Brodalumab** $1,586,086.65
Certolizumab $864,560,338.79 /
$ 123,508,619.83 $ 52,561,847.17 $367,932,930.20
PEGol
$128,453,767.80 /
$ 64,226,883.90 $ 37,296,261.35
Dupilumab** $74,592,522.69
$9,520,996,672.78 /
$ 1,360,142,381.83 $ 448,921,764.56
Etanercept $3,142,452,351.95
$86,482,584.20 /
Guselkumab** $ 43,241,292.10 $ 14,282,730.12 $28,565,460.24
$427,598,950.43 /
Infliximab $ 61,085,564.35 $ 212,841,336.46 $1,489,889,355.25
$216,040,622.21 /
Ixekizumab** $ 72,013,540.74 $ 27,530,915.27 $82,592,745.80
$276,131,049.00 /
Rituximab $ 39,447,292.71 $ 147,901,298.72 $1,035,309,091.07
$720,852,899.78 /
Secukinumab** $ 180,213,224.95 $ 89,076,631.68 $356,306,526.71
$1,756,228,382.08 /
Ustekinumab $ 250,889,768.87 $ 127,529,534.19 $892,706,739.31
$500,000
$400,000
$300,000
$300,000
$200,000
$100,000
500M
500M
400M

300M
200M
100M
K
201
2016 2017 2018 Mean
$1,969.07 $2,237.00 $2,462.41 1683
$198.65 $200.61 $212.50 168
$42.97 $49.57 $54.81 43
$1,188.66 $1,192.40 1191
$3,448.44 $3,819.16 $4,107.98 3114
$719.14 $736.25 728
$964.11 $1,119.38 $1,228.69 830
$9,766.13 $10,259.39 10013
$812.27 $1,005.30 $940.08 824
$4,357.20 $4,770.81 $5,239.52 4789
$78.85 $307.18 $324.70 141
$3,036.42 $3,301.50 $3,584.79 3165
$17,154.78 $18,838.34 $20,561.47 16075
$1,910.87 $2,158.38 $2,257.89 1619
$195.09 $198.12 $193.68 163
$42.74 $48.52 $48.08 41

$1,073.68 1074
$2,878.20 $3,177.07 $3,180.54 2629
$708.33 $651.61 680
$916.48 $1,046.25 $1,091.42 782
$9,534.27 $9,318.20 9426
$785.30 $679.55 $694.24 688
$4,265.69 $4,759.47 $4,679.21 4568
$70.76 $81.28 $79.47 70
$2,982.04 $3,251.66 $3,324.41 2948
$16,553.34 $16,533.93 $17,274.02 14863
2016 2017 2018 Mean
$2,197,988,894.42 $2,638,536,619.67 $3,063,870,449.08 1776053281
$10,858,650.70 $11,899,227.85 $13,197,063.41 8289419
$162,941,986.97 $243,149,800.87 $318,273,429.22 162414103
$123,026.25 $3,135,421.24 1629224
$160,787,675.01 $164,587,668.71 $164,604,113.84 123508620

$26,650,729.76 $101,803,038.04 64226884
$1,572,136,216.02 $1,761,076,674.34 $1,904,972,782.22 1360142382
$9,424,317.32 $77,058,266.88 43241292
$68,074,955.32 $83,457,058.05 $91,962,414.80 61085564
$14,539,145.93 $70,979,492.10 $130,521,984.18 72013541
$45,242,671.02 $49,841,335.96 $55,074,083.81 39447293
$107,321,944.21 $220,359,536.45 $369,998,622.61 180213225
$265,156,009.82 $406,047,544.41 $582,683,696.71 250889769
$1,282,754,970.54 $1,641,831,319.28 $1,748,346,359.77 936185436
$10,981,809.04 $12,868,092.48 $13,444,219.52 8795349
$57,960,391.56 $81,641,258.07 $93,736,396.03 51165748
$1,586,086.65 1586087
$68,613,182.43 $72,398,822.77 $75,233,732.20 52561847
$14,847,251.03 $59,745,271.66 37296261
$600,736,099.99 $665,720,917.07 $645,104,132.63 448921765
$3,098,637.80 $25,466,822.44 14282730
$277,833,978.10 $277,071,588.34 $304,428,715.05 212841336
$3,833,692.54 $26,297,408.36 $52,461,644.90 27530915
$177,010,013.36 $210,388,857.75 $196,579,598.56 147901299
$49,604,736.83 $112,310,172.34 $185,417,236.55 89076632

$143,951,167.37 $228,530,191.00 $334,701,308.37 127529534
t D vs. Medicaid Spending for Immunomodulators (2012-2018)

2014 2015 2016 2017 2018
Year
ab Medicaid Anakinra Medicare D Anakinra Medicaid Apremilast Medicare D

b Medicare D Certolizumab Medicare D Certolizumab Medicaid Dupilumab Medicare D
Medicare D Etanercept Medicaid Guselkumab Medicare D Guselkumab Medicaid
Medicaid Ixekizumab Medicare D Ixekizumab Medicaid Rituximab Medicare D
ab Medicare D Secukinumab Medicaid Ustekinumab Medicare D Ustekinumab Medicaid
Mean Growth Rate Percent Change in Percent Change in Avg Spending per
of Total Spending: Total Spending Total Spending dosage unit 2012-
Medicare Medicare D (from Medicaid (from
D/Medicaid 2012 to 2018) 2012 to 2018) 18 (Medicare D)
354.17% (+ 558.44% /
28.98% / 38.57% $ 1,683.04
$2,389,261,318.80) $1,482,818,889.93
207.32% (+ 212.71% /
112.29% / 21.83% $ 168.19
$8,902,828.38) $9,145,025.27
2565.29% (+ 5418.67% /
182% / 339.64% $ 43.12
$306,332,010.49) $92,037,864.99
2448.58% / N/A 2448.58% (+ N/A $ 1,190.53

$3,012,394.99)
193.18% (+ 188.1% /
20.7% / 19.87% $108,460,379.93) $49,120,359.06 $ 3,114.46
281.99% (+ 302.4% /
281.99% / 302.40% $ 727.70
$75,152,308.28) $44,898,020.63
163.73% (+ 190.42% /
17.87% / 20.49% $ 829.89
$1,182,658,703.10) $422,978,940.39
717.65% 721.87% /
717.65% / 721.87% (+67,633,949.56) $22,368,184.64 $ 10,012.76
198.56% 149.09% /
20.39% / 17.09% (+61,160,195.18) $182,213,064.40 $ 824.20
797.73% (+ 1268.44% /
236.04% / 342.72% $115,982,838.25) $48,627,952.36 $ 4,789.18
147.94% (+ 112.72% /
16.74% / 13.97% $32,861,032.69) $104,168,084.09 $ 140.91
1966.07% /
1496.69% (+ $176,442,855.56
178.79% / 214.75% $346,825,826.10) $ 3,164.58
1057.04% (+ 1776.54% /
51.62% / 63.25% $532,323,714.24) $316,865,193.74 $ 16,075.17
Total Medicare Part D vs. Medicaid Spending for Immunomodula
$500,000,000.00
$400,000,000.00
$300,000,000.00
$300,000,000.00
$200,000,000.00
$100,000,000.00
$0.00
2012 2013 2014 2015
Year
Adalimumab Medicare D Adalimumab Medicaid Anakinra Medicare D A

Apremilast Medicaid Brodalumab Medicare D Certolizumab Medicare D C
Dupilumab Medicaid Etanercept Medicare D Etanercept Medicaid G
Infliximab Medicare D Infliximab Medicaid Ixekizumab Medicare D I
Rituximab Medicaid Secukinumab Medicare D Secukinumab Medicaid U
Total Medicare Part D vs. Medicaid Spending for Immunomodula
500M
500M
400M
300M
200M
100M
K
2012 2013 2014 2015
Year
% Change Change in Dollar Ammount
142.06% $1,445.14 145.50%
110.68% $111.63
71.88% $22.92
0.31% $3.74
89.34% $1,938.31
2.38% $17.11
154.36% $745.64
5.05% $493.26
45.95% $295.95
20.25% $882.33
402.25% $260.05
31.04% $849.19
73.90% $8,737.73
124.71% $1,253.08
97.44% $95.59
54.63% $16.99
N/A N/A
63.44% $1,234.49
-8.01% -$56.72
124.02% $604.23
-2.27% -$216.07
12.01% $74.45
9.69% $413.53
34.92% $20.57
48.94% $1,092.32
47.82% $5,587.87
Total Spending over Change in Dollar

% Change all years Amount
354.17% $12,432,372,969.53 $2,389,261,318.80
207.32% $58,025,934.00 $8,902,828.38
2565.29% $812,070,516.60 $306,332,010.49
2448.58% $3,258,447.49 $3,012,394.99
193.18% $864,560,338.79 $108,460,379.93

281.99% $128,453,767.80 $75,152,308.28
163.73% $9,520,996,672.78 $1,182,658,703.10
717.65% $86,482,584.20 $67,633,949.56
198.56% $427,598,950.43 $61,160,195.18
797.73% $216,040,622.21 $115,982,838.25
147.94% $276,131,049.00 $32,861,032.69
1496.69% $720,852,899.78 $346,825,826.10
1057.04% $1,756,228,382.08 $532,323,714.24
558.44% $6,553,298,052.37 $1,482,818,889.93
212.71% $61,567,442.60 $9,145,025.27
5418.67% $255,828,740.45 $92,037,864.99
N/A $1,586,086.65 N/A
188.10% $367,932,930.20 $49,120,359.06
302.40% $74,592,522.69 $44,898,020.63
190.42% $3,142,452,351.95 $422,978,940.39
721.87% $28,565,460.24 $22,368,184.64
149.09% $1,489,889,355.25 $182,213,064.40
1268.44% $82,592,745.80 $48,627,952.36
112.72% $1,035,309,091.07 $104,168,084.09
1966.07% $356,306,526.71 $176,442,855.56

1776.54% $892,706,739.31 $316,865,193.74
Total Medicare Part D vs. Medicaid Spe
3000M
2500M
2000M
1500M
1000M
500M
500M
2018
emilast Medicare D K
2012 2013 2014 2015
ilumab Medicare D
elkumab Medicaid
ximab Medicare D Year
ekinumab Medicaid
Mean Growth Rate Percent Change in Percent Change in

Avg Spending per of Avg Spending Per Avg Spending Per Avg Spending Per
dosage unit 2012-18 Dosage Unit: Dosage Unit Dosage Unit
(Medicaid) Medicare Medicare D (from Medicaid (from
D/Medicaid 2012 to 2018) 2012 to 2018)
124.71% (+
$ 1,619.31 15.96% / 14.59% 142.06% (+$1,445.14)
$1,253.08)
$ 162.60 13.65% / 12.59% 110.68% (+$111.63) 97.44% (+$95.59)
$ 41.24 14.53% / 11.79% 71.88% (+$22.92) 54.63% (+$16.99)
$ 1,073.68 0.31% / N/A 0.31% (+$3.74) N/A
$ 2,629.18 11.25% / 9.14% 89.34% (+$1,938.31) 63.44% (+$1,234.49)
$ 679.97 2.38% / -8.01% 2.38% (+$17.11) -8.01% (-$56.72)
$ 781.60 16.90% / 14.53% 154.36% (+$745.64) 124.02% (+$604.23)
$ 9,426.23 5.05% / -2.27% 5.05% (+$493.26) -2.27% (-$216.07)
$ 688.02 7.04% / 2.26% 45.95% (+$295.95) 12.01% (+$74.45)

$ 4,568.12 9.66% / 4.94% 20.25% (+$882.33) 9.69% ($413.53)
$ 69.60 52.61% / 5.25% 402.25% (+$260.05) 34.92% (+$20.57)
$ 2,947.55 9.44% / 14.96% 31.04% (+$849.19) 48.94% (+$1,092.32)
$ 14,862.50 9.68% / 7.22% 73.90% (+$8,737.73) 47.82% (+$5,587.87)
dicaid Spending for Immunomodulators (2012-2018)

2015 2016 2017 2018
Year
Anakinra Medicare D Anakinra Medicaid Apremilast Medicare D

Certolizumab Medicare D Certolizumab Medicaid Dupilumab Medicare D
Etanercept Medicaid Guselkumab Medicare D Guselkumab Medicaid
Ixekizumab Medicare D Ixekizumab Medicaid Rituximab Medicare D
Secukinumab Medicaid Ustekinumab Medicare D Ustekinumab Medicaid
dicaid Spending for Immunomodulators (2012-2018)

2015 2016 2017 2018
Year
% Change
Immunomodulators 2012 2013 (2012-2013) 2014
Adalimumab $1,017.27 $1,150.67 13.11% $1,328.44
Medicare D
$100.86 $133.85 32.71% $157.17

Anakinra Medicare D
Apremilast Medicare $31.89
D
Brodalumab
Medicare D
Certolizumab $2,169.67 $2,412.60 11.20% $2,778.18
Medicare D
Dupilumab Medicare
D
Etanercept Medicare $483.05 $570.26 18.05% $658.30
D
Guselkumab
Medicare D
Infliximab Medicare $644.13 $736.65 14.36% $829.47
D
Ixekizumab
Medicare D
Rituximab Medicare $64.65 $66.23 2.44% $70.51
D
Secukinumab
Medicare D
Ustekinumab $11,823.74 $13,326.35 12.71% $14,608.74
Medicare D
Adalimumab $1,004.81 $1,124.44 11.90% $1,300.00

Medicaid
$98.10 $127.54 30.01% $157.16

Anakinra Medicaid
$31.09
Apremilast Medicaid
Brodalumab
Medicaid
Certolizumab $1,946.05 $2,241.29 15.17% $2,630.39
Medicaid
Dupilumab Medicaid
$487.19 $547.69 12.42% $630.58

Etanercept Medicaid
Guselkumab
Medicaid
$619.79 $610.86 -1.44% $684.48

Infliximab Medicaid
Ixekizumab Medicaid
$58.90 $62.80 6.62% $64.81

Rituximab Medicaid
Secukinumab
Medicaid
Ustekinumab $11,686.15 $11,532.53 -1.31% $15,037.77
Medicaid
% Change
Immunomodulators 2012 2013 (2012-2013) 2014
Adalimumab $674,609,130.28 $955,331,810.70 41.61% $1,239,853,884.21
Medicare D
$4,294,235.03 $1,004,994.19 -76.60% $8,004,714.44

Anakinra Medicare D
Apremilast Medicare $11,941,418.73
D
Brodalumab
Medicare D
Certolizumab $56,143,733.91 $76,965,425.43 37.09% $109,925,510.93
Medicare D
Dupilumab Medicare
D
Etanercept Medicare $722,314,079.12 $976,955,478.64 35.25% $1,198,397,787.78
D
Guselkumab
Medicare D
Infliximab Medicare $30,802,219.62 $42,902,833.37 39.28% $52,615,463.95
D
Ixekizumab
Medicare D
Rituximab Medicare $22,213,051.12 $30,301,486.67 36.41% $35,629,300.64
D
Secukinumab
Medicare D
Ustekinumab $50,359,982.47 $89,501,701.78 77.72% $157,144,756.23
Medicare D
Adalimumab $265,527,469.84 $332,779,406.13 25.33% $474,282,605.92

Medicaid
$4,299,194.25 $5,649,574.47 31.41% $6,932,749.83

Anakinra Medicaid
$1,698,531.04
Apremilast Medicaid
Brodalumab
Medicaid
Certolizumab $26,113,373.14 $31,080,599.40 19.02% $40,191,238.86
Medicaid
Dupilumab Medicaid
$222,125,192.24 $255,804,307.86 15.16% $306,152,210.01

Etanercept Medicaid
Guselkumab
Medicaid
$122,215,650.65 $129,283,305.35 5.78% $167,096,025.71

Infliximab Medicaid
Ixekizumab Medicaid
92,411,514 $97,561,822.54 5.57% $116,462,999.88

Rituximab Medicaid
Secukinumab
Medicaid
Ustekinumab $17,836,114.63 $29,799,659.34 67.07% $51,719,138.20
Medicaid
l Medicare Part D vs. Medicaid Spending for Immunomodulators (2012-2018) Adalimumab

Medicare D
Adalimumab
Medicaid
Anakinra Medicar
Anakinra Medicai
Apremilast Medic
D
Apremilast Medic
Brodalumab
Medicare D
Certolizumab
Medicare D
Certolizumab
Medicaid
Dupilumab Medic
D
Dupilumab Medic
Etanercept Medic
D
Etanercept Medic
Guselkumab
Medicare D
Guselkumab
Medicaid
Infliximab Medica
D
Infliximab Medica
Ixekizumab Medic
D
Ixekizumab Medic
Rituximab Medica
D
Rituximab Medica
Secukinumab
Medicare D
Ixekizumab Medic
Rituximab Medica
D
Rituximab Medica
Secukinumab
Medicare D
Secukinumab
Medicaid
Ustekinumab
Medicare D
Ustekinumab
2014 2015 2016 2017 2018 Medicaid
Year
Avg Medicare Part D vs. Medicaid Spen
$4,000
$3,500
$3,000
Spending Per Dosage Unit (USD)
$2,500
$2,000
Avg. Spending Per Dosage Unit (
$2,000
$1,500
$1,000
$500
$0
2018 2012 2013 2014
D Adalimumab Medicare D Adalimumab Medicaid

D Apremilast Medicaid Brodalumab Medicare D
d Dupilumab Medicaid Etanercept Medicare D
D Infliximab Medicare D Infliximab Medicaid
d Rituximab Medicaid Secukinumab Medicare D
Avg Medicare Part D vs. Medicaid Spen
$4,000
$3,500
$3,000
$3,500
$3,000
$2,500

$2,000
$1,500
$1,000
$500
$0
2018 2012 2013 2014
% Change % Change % Change
(2013-2014) 2015 (2014-2015) 2016 (2015-2016) 2017
15.45% $1,616.41 21.68% $1,969.07 21.82% $2,237.00
17.42% $173.65 10.49% $198.65 14.39% $200.61
$36.37 14.05% $42.97 18.17% $49.57
$1,188.66
15.15% $3,065.20 10.33% $3,448.44 12.50% $3,819.16
$719.14
15.44% $785.48 19.32% $964.11 22.74% $1,119.38
$9,766.13
12.60% $801.50 -3.37% $812.27 1.34% $1,005.30
$4,357.20 $4,770.81
6.46% $74.23 5.28% $78.85 6.22% $307.18
$2,735.60 $3,036.42 11.00% $3,301.50
9.62% $16,212.79 10.98% $17,154.78 5.81% $18,838.34
15.61% $1,578.75 21.44% $1,910.87 21.04% $2,158.38
23.22% $168.52 7.23% $195.09 15.77% $198.12
$35.77 15.05% $42.74 19.49% $48.52

17.36% $2,350.75 -10.63% $2,878.20 22.44% $3,177.07
$708.33
15.14% $751.59 19.19% $916.48 21.94% $1,046.25
$9,534.27
12.05% $741.93 8.39% $785.30 5.84% $679.55
$4,265.69 $4,759.47
3.20% $69.16 6.71% $70.76 2.31% $81.28
$2,232.09 $2,982.04 33.60% $3,251.66
30.39% $15,419.79 2.54% $16,553.34 7.35% $16,533.93
% Change % Change % Change

(2013-2014) 2015 (2014-2015) 2016 (2015-2016) 2017
29.78% $1,662,182,181.17 34.06% $2,197,988,894.42 32.24% $2,638,536,619.67
696.49% $8,767,048.38 9.52% $10,858,650.70 23.86% $11,899,227.85
$75,763,880.81 534.46% $162,941,986.97 115.07% $243,149,800.87
$123,026.25
42.82% $131,546,210.96 19.67% $160,787,675.01 22.23% $164,587,668.71

$26,650,729.76
22.67% $1,385,143,654.66 15.58% $1,572,136,216.02 13.50% $1,761,076,674.34
$9,424,317.32
22.64% $57,784,005.32 9.82% $68,074,955.32 17.81% $83,457,058.05
$14,539,145.93 $70,979,492.10
17.58% $37,829,119.78 6.17% $45,242,671.02 19.60% $49,841,335.96
$23,172,796.51 $107,321,944.21 363.14% $220,359,536.45
75.58% $205,334,690.66 30.67% $265,156,009.82 29.13% $406,047,544.41
42.52% $807,775,920.89 70.32% $1,282,754,970.54 58.80% $1,641,831,319.28
22.71% $7,391,803.01 6.62% $10,981,809.04 48.57% $12,868,092.48
$20,792,163.75 1124.13% $57,960,391.56 178.76% $81,641,258.07
29.31% $54,301,981.40 35.11% $68,613,182.43 26.35% $72,398,822.77
$14,847,251.03
19.68% $446,809,492.15 45.94% $600,736,099.99 34.45% $665,720,917.07
$3,098,637.80
29.25% $211,960,092.05 26.85% $277,833,978.10 31.08% $277,071,588.34
$3,833,692.54 $26,297,408.36
19.37% $144,894,284.51 24.41% $177,010,013.36 22.16% $210,388,857.75
$8,974,380.99 $49,604,736.83 452.74% $112,310,172.34

73.56% $86,169,160.40 66.61% $143,951,167.37 67.06% $228,530,191.00
Adalimumab
Medicare D
Avg Medicare Part D vs. Medicai
Adalimumab
Medicaid
Anakinra Medicare D
Anakinra Medicaid
Apremilast Medicare $20,000

D
Apremilast Medicaid
Brodalumab
Medicare D
Certolizumab
Medicare D
Certolizumab
Medicaid
Dupilumab Medicare $15,000

D
Dupilumab Medicaid
Etanercept Medicare
Avg Spending Per Dosage Unit (USD)
Etanercept Medicaid
Guselkumab
Medicare D
Guselkumab
Medicaid $10,000
Infliximab Medicare
D
Infliximab Medicaid
Ixekizumab Medicare
D
Ixekizumab Medicaid
Rituximab Medicare
D
$5,000
Rituximab Medicaid
Secukinumab
Medicare D
Ixekizumab Medicaid
Rituximab Medicare
D
$5,000
Rituximab Medicaid
Secukinumab
Medicare D
Secukinumab
Medicaid
Ustekinumab
Medicare D
Ustekinumab
2018 Medicaid
$0
2012 2013 2014
are Part D vs. Medicaid Spending Per Dosage Unit for Immunomodulators (2012-2018)
2014 2015 2016 2017 2
Year
Adalimumab Medicaid Anakinra Medicare D Anakinra Medicaid Apremilast Medicare D

Brodalumab Medicare D Certolizumab Medicare D Certolizumab Medicaid Dupilumab Medicare D
Etanercept Medicare D Etanercept Medicaid Guselkumab Medicare D Guselkumab Medicaid
Infliximab Medicaid Ixekizumab Medicare D Ixekizumab Medicaid Rituximab Medicare D
Secukinumab Medicare D Secukinumab Medicaid Ustekinumab Medicare D Ustekinumab Medicaid
are Part D vs. Medicaid Spending Per Dosage Unit for Immunomodulators (2012-2018)
2014 2015 2016 2017 2
Year
% Change % Change Immunomodula
(2016-2017) 2018 (2017-2018) Mean tors
13.61% $2,462.41 10.08% 1683 Adalimumab

Medicare D
0.99% $212.50 5.93% 168 Anakinra

Medicare D
15.34% $54.81 10.58% 43 Apremilast

Medicare D
$1,192.40 0.31% 1191 Brodalumab

Medicare D
10.75% $4,107.98 7.56% 3114 Certolizumab

Medicare D
$736.25 2.38% 728 Dupilumab

Medicare D
16.11% $1,228.69 9.76% 830 Etanercept

Medicare D
$10,259.39 5.05% 10013 Guselkumab

Medicare D
23.76% $940.08 -6.49% 824 Infliximab

Medicare D
9.49% $5,239.52 9.82% 4789 Ixekizumab

Medicare D
289.57% $324.70 5.70% 141 Rituximab

Medicare D
8.73% $3,584.79 8.58% 3165 Secukinumab

Medicare D
9.81% $20,561.47 9.15% 16075 Ustekinumab

Medicare D
12.95% $2,257.89 4.61% 1619 Adalimumab

Medicaid
1.56% $193.68 -2.24% 163 Anakinra

Medicaid
13.52% $48.08 -0.92% 41 Apremilast

Medicaid
$1,073.68 1074 Brodalumab
Medicaid
10.38% $3,180.54 0.11% 2629 Certolizumab

Medicaid
$651.61 -8.01% 680 Dupilumab

Medicaid
14.16% $1,091.42 4.32% 782 Etanercept

Medicaid
$9,318.20 -2.27% 9426 Guselkumab

Medicaid
-13.47% $694.24 2.16% 688 Infliximab

Medicaid
11.58% $4,679.21 -1.69% 4568 Ixekizumab

Medicaid
14.87% $79.47 -2.23% 70 Rituximab

Medicaid
9.04% $3,324.41 2.24% 2948 Secukinumab

Medicaid
-0.12% $17,274.02 4.48% 14863 Ustekinumab

Medicaid
% Change % Change Immunomodula

(2016-2017) 2018 (2017-2018) Mean tors
20.04% $3,063,870,449.08 16.12% 1776053281 Adalimumab

Medicare D
9.58% $13,197,063.41 10.91% 8289419 Anakinra

Medicare D
49.22% $318,273,429.22 30.90% 162414103 Apremilast

Medicare D
$3,135,421.24 2448.58% 1629224 Brodalumab

Medicare D
2.36% $164,604,113.84 0.01% 123508620 Certolizumab

Medicare D
$101,803,038.04 281.99% 64226884 Dupilumab
Medicare D
12.02% $1,904,972,782.22 8.17% 1360142382 Etanercept

Medicare D
$77,058,266.88 717.65% 43241292 Guselkumab

Medicare D
22.60% $91,962,414.80 10.19% 61085564 Infliximab

Medicare D
388.20% $130,521,984.18 83.89% 72013541 Ixekizumab

Medicare D
10.16% $55,074,083.81 10.50% 39447293 Rituximab

Medicare D
105.33% $369,998,622.61 67.91% 180213225 Secukinumab

Medicare D
53.14% $582,683,696.71 43.50% 250889769 Ustekinumab

Medicare D
27.99% $1,748,346,359.77 6.49% 936185436 Adalimumab

Medicaid
17.18% $13,444,219.52 4.48% 8795349 Anakinra

Medicaid
40.86% $93,736,396.03 14.81% 51165748 Apremilast

Medicaid
$1,586,086.65 1586087 Brodalumab

Medicaid
5.52% $75,233,732.20 3.92% 52561847 Certolizumab

Medicaid
$59,745,271.66 302.40% 37296261 Dupilumab

Medicaid
10.82% $645,104,132.63 -3.10% 448921765 Etanercept

Medicaid
$25,466,822.44 721.87% 14282730 Guselkumab

Medicaid
-0.27% $304,428,715.05 9.87% 212841336 Infliximab

Medicaid
585.96% $52,461,644.90 99.49% 27530915 Ixekizumab

Medicaid
18.86% $196,579,598.56 -6.56% 147901299 Rituximab

Medicaid
126.41% $185,417,236.55 65.09% 89076632 Secukinumab

Medicaid
58.76% $334,701,308.37 46.46% 127529534 Ustekinumab
Medicaid
re Part D vs. Medicaid Spending Per Dosage Unit for Immunomodulators (2012-2018)
Adalimumab Medicare
Adalimumab Medicaid
Anakinra Medicare D
Anakinra Medicaid
Apremilast Medicaid
Brodalumab Medicare
Certolizumab Medicare
Dupilumab Medicare D
Dupilumab Medicaid
Etanercept Medicaid
Guselkumab Medicare
Guselkumab Medicaid
Infliximab Medicaid
Ixekizumab Medicaid
Rituximab Medicaid
Ixekizumab Medicaid
Rituximab Medicaid
Secukinumab Medicare
Ustekinumab Medicare
2014 2015 2016 2017 2018 Ustekinumab Medicaid
Year
17 2018
Guselkumab Medicaid
Ustekinumab Medicaid
17 2018
% Change in Avg. Spending Per Dosage Unit
2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 2017-2018 Mean
13.11% 15.45% 21.68% 21.82% 13.61% 10.08% 1683
32.71% 17.42% 10.49% 14.39% 0.99% 5.93% 168
14.05% 18.17% 15.34% 10.58% 43
0.31% 1191
11.20% 15.15% 10.33% 12.50% 10.75% 7.56% 3114
2.38% 728
18.05% 15.44% 19.32% 22.74% 16.11% 9.76% 830
5.05% 10013
14.36% 12.60% -3.37% 1.34% 23.76% -6.49% 824
9.49% 9.82% 4789
2.44% 6.46% 5.28% 6.22% 289.57% 5.70% 141
11.00% 8.73% 8.58% 3165
12.71% 9.62% 10.98% 5.81% 9.81% 9.15% 16075
11.90% 15.61% 21.44% 21.04% 12.95% 4.61% 1619
30.01% 23.22% 7.23% 15.77% 1.56% -2.24% 163
15.05% 19.49% 13.52% -0.92% 41

1074
15.17% 17.36% -10.63% 22.44% 10.38% 0.11% 2629
-8.01% 680
12.42% 15.14% 19.19% 21.94% 14.16% 4.32% 782
-2.27% 9426
-1.44% 12.05% 8.39% 5.84% -13.47% 2.16% 688
11.58% -1.69% 4568
6.62% 3.20% 6.71% 2.31% 14.87% -2.23% 70
33.60% 9.04% 2.24% 2948
-1.31% 30.39% 2.54% 7.35% -0.12% 4.48% 14863
% Change in Total Spending (USD)
2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 2017-2018 Mean
41.61% 29.78% 34.06% 32.24% 20.04% 16.12% 1776053281
-76.60% 696.49% 9.52% 23.86% 9.58% 10.91% 8289419
534.46% 115.07% 49.22% 30.90% 162414103
2448.58% 1629224
37.09% 42.82% 19.67% 22.23% 2.36% 0.01% 123508620

281.99% 64226884
35.25% 22.67% 15.58% 13.50% 12.02% 8.17% 1360142382
717.65% 43241292
39.28% 22.64% 9.82% 17.81% 22.60% 10.19% 61085564
388.20% 83.89% 72013541
36.41% 17.58% 6.17% 19.60% 10.16% 10.50% 39447293
363.14% 105.33% 67.91% 180213225
77.72% 75.58% 30.67% 29.13% 53.14% 43.50% 250889769
25.33% 42.52% 70.32% 58.80% 27.99% 6.49% 936185436
31.41% 22.71% 6.62% 48.57% 17.18% 4.48% 8795349
1124.13% 178.76% 40.86% 14.81% 51165748
1586087
19.02% 29.31% 35.11% 26.35% 5.52% 3.92% 52561847
302.40% 37296261
15.16% 19.68% 45.94% 34.45% 10.82% -3.10% 448921765
721.87% 14282730
5.78% 29.25% 26.85% 31.08% -0.27% 9.87% 212841336
585.96% 99.49% 27530915
5.57% 19.37% 24.41% 22.16% 18.86% -6.56% 147901299
452.74% 126.41% 65.09% 89076632

67.07% 73.56% 66.61% 67.06% 58.76% 46.46% 127529534
Avg Medicare Part D vs. Me

2-2018)
Adalimumab Medicaid
Anakinra Medicare D $20,000
Anakinra Medicaid
Apremilast Medicaid
$15,000
Dupilumab Medicaid
$10,000
Etanercept Medicaid
Guselkumab Medicare D
Guselkumab Medicaid
Infliximab Medicaid
$5,000
Ixekizumab Medicaid
Rituximab Medicaid
$5,000
Ixekizumab Medicaid
Rituximab Medicaid
Secukinumab Medicare D $0
2012 2013
Ustekinumab Medicare D
Adalimumab Medicare D Adalimumab
Apremilast Medicaid Brodalumab
2018 Ustekinumab Medicaid
Dupilumab Medicaid Etanercept M
Infliximab Medicare D Infliximab M
Rituximab Medicaid Secukinuma
% Change in Avg. Spending Per Dosage Unit
Annual Annual
Growth Rate Growth Rate
Mean Avg. Mean Avg. for Average for Average
Average Medicare D Medicaid Medicare D Medicaid
Annual Spending Per Spending Per Sepnding Per Sepnding Per
Growth Rate Dosage Dosage Dosage Dosage
15.96% 18.16% 1683 1619 15.96% 14.59%

Adalimumab
13.65% 168 163 13.65% 12.59%

Anakinra
14.53% 43 41 14.53% 11.79%

Apremilast
0.31% 1191 1074 0.31% N/A

Brodalumab
11.25% 3114 2629 11.25% 9.14%

Certolizumab
2.38% 728 680 2.38% -8.01%

Dupilumab
16.90% 830 782 16.90% 14.53%

Etanercept
5.05% 10013 9426 5.05% -2.27%

Guselkumab
7.04% 824 688 7.04% 2.26%

Infliximab
9.66% 4789 4568 9.66% 4.94%

Ixekizumab
52.61% 141 70 52.61% 5.25%

Rituximab
9.44% 3165 2948 9.44% 14.96%

Secukinumab
9.68% 16075 14863 9.68% 7.22%

M e a n in A v e r a g e S p e n d in g P e r D o s a g e U n it ( U S D )
Ustekinumab
14.59%
12.59%
11.79%
Mean and Annual Growth Rate for Average Medicare Part D and Medicai
M e a n in A v e r a g e S p e n d in g P e
N/A
9.14%
Mean and Annual Growth Rate for Average Medicare Part D and Medicai
-8.01% 18000 60.00%
16000 50.00%
14.53% 14000
40.00%
12000
30.00%
-2.27%
10000
20.00%
8000
2.26% 10.00%
6000
0.00%
4.94% 4000
2000 -10.00%
5.25% 0 -20.00%
1 2 3 4 5 6 7 8 9 10 11 12 13
Mean Avg. Medicare D Spending Per Dosage

14.96% Mean Avg. Medicaid Spending Per Dosage
Annual Growth Rate for Average Medicare D Sepnding Per Dosage
Annual Growth Rate for Average Medicaid Sepnding Per Dosage
7.22%
Average Average
Annual Annual
Mean Total Mean Total Growth Rate Growth Rate
Medicare D Medicaid for Total for Total
Spending Spending
Medicare D Medicaid
Sepnding Sepnding
Average Adalimumab 1776053281 936185436 28.98% 38.57%

Annual
Growth Rate
28.98% Anakinra 8289419 8795349 112.29% 21.83%
112.29% Apremilast 162414103 51165748 182.41% 339.64%
182.41% Brodalumab 1629224 1586087 2448.58% N/A
2448.58% Certolizumab 123508620 52561847 20.70% 19.87%
20.70% Dupilumab 64226884 37296261 281.99% 302.40%

281.99% Etanercept 1360142382 448921765 17.87% 20.49%
17.87% Guselkumab 43241292 14282730 717.65% 721.87%
717.65% Infliximab 61085564 212841336 20.39% 17.09%
20.39% Ixekizumab 72013541 27530915 236.04% 342.72%
236.04% Rituximab 39447293 147901299 16.74% 13.97%
16.74% Secukinumab 180213225 89076632 178.79% 214.75%
178.79% Ustekinumab 250889769 127529534 51.62% 63.25%
51.62%
38.57%
Mean and Annual Growth Rate in Total Medicare Part D and Medicaid Spending
21.83% 2000000000 3000.00%
1800000000
339.64%
2500.00%
1600000000
N/A
1400000000
2000.00%
Mean Total Spending (USD)
19.87% 1200000000
1000000000 1500.00%
302.40%
800000000
20.49% 1000.00%
600000000
400000000
721.87% 500.00%
200000000
17.09%
0 0.00%
ab ra s t ab ab ab t ab ab ab ab ab ab
kin i la ep
um um izum ilum rc m xim izum uxim inum inum
342.72% im An
a
re
m
dal l p a ne e lku fli k t k k
al p o rto Du E t us I n
Ixe Ri cu te
A d A Br Ce G Se Us
13.97%
Mean Total Medicare D Spending
Mean Total Medicaid Spending
214.75% Average Annual Growth Rate for Total Medicare D Sepnding
Average Annual Growth Rate for Total Medicaid Sepnding
Mean Total Medicare D Spending
Mean Total Medicaid Spending
Average Annual Growth Rate for Total Medicare D Sepnding
Average Annual Growth Rate for Total Medicaid Sepnding
63.25%
Avg Medicare Part D vs. Medicaid Spending Per Dosage Unit for Immunomodulators (2012-2018)
2013 2014 2015 2016 2017
Year
umab Medicare D Adalimumab Medicaid Anakinra Medicare D Anakinra Medicaid Apremilast Med
ast Medicaid Brodalumab Medicare D Certolizumab Medicare D Certolizumab Medicaid Dupilumab Med
ab Medicaid Etanercept Medicare D Etanercept Medicaid Guselkumab Medicare D Guselkumab Me
ab Medicare D Infliximab Medicaid Ixekizumab Medicare D Ixekizumab Medicaid Rituximab Med
ab Medicaid Secukinumab Medicare D Secukinumab Medicaid Ustekinumab Medicare D Ustekinumab M
Percent Change Each Year in Average Medicare Part D Spending Per Dosage Unit for Imm
2018)
350.00%
300.00%
250.00%
200.00%
150.00%
100.00%
50.00%
0.00%
2012-2013 2013-2014 2014-2015 2015-2016 2016-2
A n n u a l G r o w th R a te in A v e r a g e S p e n d in g P e r D o s a g e U n it
-50.00%
Adalimumab Medicare D Anakinra Medicare D Apremilast Medicare D Brodalumab Medicare D

Dupilumab Medicare D Etanercept Medicare D Guselkumab Medicare D Infliximab Medicare D
Rituximab Medicare D Secukinumab Medicare D Ustekinumab Medicare D
dicare Part D and Medicaid

A n n u a l G r o w th R a te in A v e r
dicare Part D and Medicaid
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
-10.00%
-20.00%
10 11 12 13
Sepnding Per Dosage

pnding Per Dosage
Percent chage in Total Medicare Part D Spending for the Immunomodu

800.00%
700.00%
600.00%
500.00%
400.00%
300.00%
200.00%
100.00%
300.00%
200.00%
100.00%
0.00%
2012-2013 2013-2014 2014-2015 2015-2016 2016-2017
-100.00%
-200.00%
Adalimumab Medicare D Anakinra Medicare D Apremilast Medicare D Certolizum

Etanercept Medicare D Infliximab Medicare D Ixekizumab Medicare D Rituximab
Secukinumab Medicare D Ustekinumab Medicare D
D and Medicaid Spending Percent Change in Total Medicare Part D and Medicaid Spending fo
3000.00%
1200.00%
2500.00%
1000.00%
Annual Growth Rate in Total Spending
2000.00%
1500.00% 800.00%
1000.00%
600.00%
Axis Title
500.00%
400.00%
0.00%
ab ab ab
xim um um
itu kin kin
e cu s te
S U
200.00%
D Sepnding
Sepnding
0.00%
2012-2013 2013-2014 2014-2015 2015-2016 2016-2017
200.00%
D Sepnding
Sepnding
0.00%
2012-2013 2013-2014 2014-2015 2015-2016 2016-2017
-200.00%
ors (2012-2018)
2017 2018
id Apremilast Medicare D
edicaid Dupilumab Medicare D
dicare D Guselkumab Medicaid
icaid Rituximab Medicare D
edicare D Ustekinumab Medicaid
Chart Title
ing Per Dosage Unit for Immunomodulators (2012-
350.00%
300.00%
250.00%
200.00%
150.00%
2015-2016 2016-2017 2017-2018
100.00%
icare D Brodalumab Medicare D Certolizumab Medicare D

dicare D Infliximab Medicare D Ixekizumab Medicare D
edicare D
50.00%
0.00%
1 2 3
0.00%
1 2 3
-50.00%
Adalimumab Medicare D Anakinra Medicare D

Brodalumab Medicare D Certolizumab Medic
Etanercept Medicare D Guselkumab Medica
Ixekizumab Medicare D Rituximab Medicare
Ustekinumab Medicare D Adalimumab Medica
Apremilast Medicaid Brodalumab Medica
Dupilumab Medicaid Etanercept Medicaid
Infliximab Medicaid Ixekizumab Medicai
Secukinumab Medicaid Ustekinumab Medic
Average Medicare Part D vs. Medicaid Spending for Im

2018)
$6,000.00
ending for the Immunomodulators
$5,000.00
$4,000.00
Axis Title
$3,000.00
Axis Title
$3,000.00
2015-2016 2016-2017 2017-2018
$2,000.00
Apremilast Medicare D Certolizumab Medicare D

Ixekizumab Medicare D Rituximab Medicare D
$1,000.00
t D and Medicaid Spending for Immunomodulators (2012-2018)
$0.00
2012 2013 2014 2015 2016
Anakinra Medicare D
Adalimumab Medicaid
Anakinra Medicaid
Apremilast Medicaid
Brodalumab Medicaid
Etanercept Medicaid
Infliximab Medicaid
Ixekizumab Medicaid
Rituximab Medicaid
5 2015-2016 2016-2017 2017-2018

5 2015-2016 2016-2017 2017-2018

Chart Title
2 3 4 5 6
2 3 4 5 6
mab Medicare D Anakinra Medicare D Apremilast Medicare D

ab Medicare D Certolizumab Medicare D Dupilumab Medicare D
t Medicare D Guselkumab Medicare D Infliximab Medicare D
b Medicare D Rituximab Medicare D Secukinumab Medicare D
mab Medicare D Adalimumab Medicaid Anakinra Medicaid
t Medicaid Brodalumab Medicaid Certolizumab Medicaid
b Medicaid Etanercept Medicaid Guselkumab Medicaid
Medicaid Ixekizumab Medicaid Rituximab Medicaid
mab Medicaid Ustekinumab Medicaid
D vs. Medicaid Spending for Immunomodulators Per Dosage Unit (2012-
Anakinra Medicare D
Adalimumab Medicaid
Anakinra Medicaid
Apremilast Medicaid
Etanercept Medicaid
Adalimumab Medicaid
Anakinra Medicaid
Apremilast Medicaid
Etanercept Medicaid
Infliximab Medicaid
Ixekizumab Medicaid
Rituximab Medicaid
2014 2015 2016 2017 2018

RA: Rheumatoid Arthritis; JIA:
Juvenile Idiopathic Arthritis; PsA:
Psoriatic Arthritis; AS: Ankylosing
Spondylitis; CD: Adult Crohn's
Disease; UC: Ulcerative Colitis; PsO:
Plaque Psoriasis; HS: Hidradenitis
Suppurativa; Cryopyrin-Associated
Periodic Syndromes (CAPS); AD:
Atopic Dermatitis; PV: Pemphigus
Vulgaris
Approval Year for

Dermatologic
Generic Name Indications Utilization Total Spending
RA, JIA, PsA, AS, CD, Pediatric CD,
2008 $674,609,130.28
Adalimumab UC, PsO, HS
Anakinra RA; CAPS $4,294,235.03
PsA; Psoriasis; Oral Ulcers 2014
Apremilast associated with Behcet's Disease
Brodalumab PsO 2017
Certolizumab PEGol PsO, CD, RA, PsA, AS 2018 $56,143,733.91
Dupilumab AD 2017
Etanercept RA, JIA, PsA, AS, PsO 2004 $722,314,079.12
Guselkumab PsO 2017
CD, Pediatric CD, UC, Pediatric UC,
2006
Infliximab RA, AS, PsA, PsO $30,802,219.62
Ixekizumab PsO, PsA, AS 2016

Chronic Lymphocytic Leukemia, 1997
Granulomatosis with Polyangiitis,
Microscopic Polyangiitis
Rituximab $22,213,051.12
Secukinumab PsO, PsA, AS 2015
Ustekinumab PsO, PsA, CD 2009 $50,359,982.47
Calendar Year 2012
Average Average
Spending Per Average Spending
Total Total Total Dosage Dosage Unit Spending Per
Beneficiaries Claims Units (Weighted) Per Claim Beneficiary Total Spending
37,855 267,139 663,156 $1,017.27 $17,820.87

$955,331,810.70
351 2,127 42,574 $100.86 $12,234.29 $1,004,994.19
3,675 22,260 25,880 $2,169.67 $15,277.21 $76,965,425.43
42,912 307,825 1,495,328 $483.05 $16,832.45 $976,955,478.64
$17,581.18
1,752 8,240 47,820 $644.13 $42,902,833.37
$20,876.93
1,064 3,204 343,568 $64.65 $30,301,486.67
1,901 5,738 4,254 $11,823.74 $26,491.31 $89,501,701.78

Calendar Year 2013
Average
Spending Per Average Average
Total Total Total Dosage Dosage Unit Spending Per Spending Per
Beneficiaries Claims Units (Weighted) Claim Beneficiary Total Spending
53,580 325,242 828,674 $1,150.67 $4,321.87 $12,736.63 $1,239,853,884.21

88 393 7,508 $133.85 $2,557.24 $11,420.39 $8,004,714.44
$11,941,418.73
4,396 26,930 31,903 $2,412.60 $2,857.98 $17,508.06 $109,925,510.93
53,975 354,252 1,751,408 $570.26 $2,751.22 $18,108.27 $1,198,397,787.78
2,157 10,327 58,240 $736.65 $4,154.43 $19,890.05 $52,615,463.95
1,326 3,774 457,516 $66.23 $8,029.01 $22,851.80 $35,629,300.64
3,037 9,001 6,714 $13,326.35 $9,943.53 $29,470.43 $157,144,756.23

Calendar Year 2014
Average
59,141 362,301 931,166 $1,328.44 $4,990.29 $14,764.05 $1,662,182,181.17

394 2,234 50,929 $157.17 $3,583.13 $20,316.53 $8,767,048.38
2,212 6,148 374,490 $31.89 $1,942.33 $5,398.47 $75,763,880.81
4,999 30,735 39,597 $2,778.18 $3,576.56 $21,989.50 $131,546,210.96
56,796 375,300 1,849,495 $658.30 $3,179.93 $21,090.82 $1,385,143,654.66
2,338 11,346 63,433 $829.47 $4,637.36 $22,504.48 $57,784,005.32
1,559 4,111 505,329 $70.51 $8,666.82 $22,853.95 $37,829,119.78

$23,172,796.51
4,543 14,073 10,830 $14,608.74 $11,166.40 $34,590.53 $205,334,690.66
Calendar Year 2015
Average
64,933 401,014 1,026,996 $1,616.41 $6,058.60 $17,960.76 $2,197,988,894.42

398 2,336 50,486 $173.65 $3,753.02 $22,027.76 $10,858,650.70
8,024 33,283 2,085,780 $36.37 $2,276.35 $9,442.16 $162,941,986.97
5,536 33,666 42,917 $3,065.20 $3,907.39 $23,761.96 $160,787,675.01
53,715 365,654 1,783,930 $785.48 $3,773.05 $25,776.86 $1,572,136,216.02
2,296 11,286 72,095 $801.50 $5,119.97 $25,167.25 $68,074,955.32

$14,539,145.93
1,580 4,138 509,622 $74.23 $9,141.88 $23,942.48 $45,242,671.02

1,007 3,593 12,359 $2,735.60 $8,551.29 $25,519.84 $107,321,944.21
5,644 16,956 12,660 $16,212.79 $12,109.85 $36,381.06 $265,156,009.82
Calendar Year 2016
Average
Beneficiaries Claims Units (Weighted) Claim Beneficiary
69,740 447,327 1,114,095 $1,969.07 $7,326.66 $22,049.07

388 2,455 54,662 $198.65 $4,423.08 $27,986.21
11,661 60,290 3,792,918 $42.97 $2,702.64 $13,973.24
5,903 37,957 46,627 $3,448.44 $4,236.05 $27,238.30
50,106 344,507 1,649,342 $964.11 $4,546.57 $31,318.65
2,407 12,097 83,808 $812.27 $5,627.42 $28,282.08

718 1,693 3,340 $4,357.20 $9,481.46 $19,911.22
1,756 4,868 573,781 $78.85 $9,293.89 $25,764.62

3,756 17,349 48,261 $3,036.42 $7,045.35 $25,829.46
6,663 20,214 20,521 $17,154.78 $13,117.44 $39,795.29
Calendar Year 2017
Average
Spending Per Average
Total Total Total Dosage Dosage Unit Spending Per
Total Spending Beneficiaries Claims Units (Weighted) Claim
$2,638,536,619.67 73,022 477,040 1,180,746 $2,237.00 $8,313.15

$11,899,227.85 414 2,720 59,315 $200.61 $4,374.72
$243,149,800.87 13,820 77,263 4,906,678 $49.57 $3,147.04

$123,026.25 11 29 104 $1,188.66 $4,242.28
$164,587,668.71 5,346 34,528 43,097 $3,819.16 $4,766.79
$26,650,729.76 1,984 8,377 37,059 $719.14 $3,181.42
$1,761,076,674.34 48,904 344,490 1,609,495 $1,119.38 $5,278.47
$9,424,317.32 495 876 965 $9,766.13 $10,758.35
$83,457,058.05 2,661 13,379 80,125 $1,005.30 $6,073.23

$70,979,492.10 2,703 9,626 14,863 $4,770.81 $9,392.84
$49,841,335.96 1,742 4,973 579,292 $307.18 $8,548.53

$220,359,536.45 7,041 35,851 88,354 $3,301.50 $6,596.69
$406,047,544.41 8,788 27,365 46,481 $18,838.34 $14,838.21
Calendar Year 2018
Average
Average Spending Per Average
Spending Per Total Total Total Dosage Dosage Unit Spending Per
Beneficiary Total Spending Beneficiaries Claims Units (Weighted) Claim
$25,141.72 $3,063,870,449.08 73,983 499,054 1,247,471 $2,462.41 $9,214.11

$28,742.10 $13,197,063.41 480 2,912 62,105 $212.50 $4,531.96
$17,594.05 $318,273,429.22 15,945 91,021 5,809,157 $54.81 $3,496.70

$11,184.20 $3,135,421.24 169 754 2,630 $1,192.40 $4,158.38
$30,787.07 $164,604,113.84 4,936 32,056 40,071 $4,107.98 $5,134.89
$13,432.83 $101,803,038.04 5,220 32,059 138,330 $736.25 $3,175.49
$25,950.43 $1,904,972,782.22 48,443 335,392 1,576,285 $1,228.69 $5,645.31
$19,039.02 $77,058,266.88 1,997 7,301 7,511 $10,259.39 $10,554.48
$23,665.46 $91,962,414.80 2,835 14,344 85,699 $940.08 $5,103.93

$26,121.37 $130,521,984.18 4,451 17,714 24,930 $5,239.52 $10,038.53
$28,554.77 $55,074,083.81 1,852 4,956 579,465 $324.70 $9,320.13

$28,871.80 $369,998,622.61 10,529 57,741 137,854 $3,584.79 $6,838.05
$46,204.77 $582,683,696.71 9,817 34,048 53,184 $20,561.47 $17,113.60
Average
Spending Per
Beneficiary
$28,341.36
$27,493.88
$19,960.70
$18,552.79
$33,347.67
$19,502.50
$33,758.07
$38,587.01
$26,229.06
$28,343.41
$23,906.42
$32,781.44
$59,354.56
Immunomodulat 2012 2013 2014

Adalimumab
$674,609,130.28 $955,331,810.70 $1,239,853,884.21
Medicare D
Anakinra
$4,294,235.03 $1,004,994.19 $8,004,714.44
Medicare D
Apremilast
$11,941,418.73
Medicare D
Brodalumab
Medicare D
Certolizumab $56,143,733.91 $76,965,425.43 $109,925,510.93

Medicare D
Dupilumab
Medicare D
Etanercept
$722,314,079.12 $976,955,478.64 $1,198,397,787.78
Medicare D
Guselkumab
Medicare D
Infliximab
$30,802,219.62 $42,902,833.37 $52,615,463.95
Medicare D
Ixekizumab
Medicare D
Rituximab
$22,213,051.12 $30,301,486.67 $35,629,300.64
Medicare D
Secukinumab
Medicare D
Ustekinumab
$50,359,982.47 $89,501,701.78 $157,144,756.23
Medicare D
Adalimumab
$265,527,469.84 $332,779,406.13 $474,282,605.92
Medicaid
Anakinra
$4,299,194.25 $5,649,574.47 $6,932,749.83
Medicaid
Apremilast
$1,698,531.04
Medicaid
Brodalumab
Medicaid
Certolizumab
$26,113,373.14 $31,080,599.40 $40,191,238.86
Medicaid
Dupilumab
Medicaid
Etanercept
$222,125,192.24 $255,804,307.86 $306,152,210.01
Medicaid
Guselkumab
Medicaid
Infliximab
$122,215,650.65 $129,283,305.35 $167,096,025.71
Medicaid
Ixekizumab
Medicaid
Rituximab
92,411,514 $97,561,822.54 $116,462,999.88
Medicaid
Secukinumab
Medicaid
Ustekinumab
$17,836,114.63 $29,799,659.34 $51,719,138.20
Medicaid
2015 2016 2017 2018 Mean
$1,662,182,181.17 $2,197,988,894.42 $2,638,536,619.67 $3,063,870,449.08 1776053281
$8,767,048.38 $10,858,650.70 $11,899,227.85 $13,197,063.41 8289419
$75,763,880.81 $162,941,986.97 $243,149,800.87 $318,273,429.22 162414103
$123,026.25 $3,135,421.24 1629224
$131,546,210.96 $160,787,675.01 $164,587,668.71 $164,604,113.84 123508620
$26,650,729.76 $101,803,038.04 64226884
$1,385,143,654.66 $1,572,136,216.02 $1,761,076,674.34 $1,904,972,782.22 1360142382
$9,424,317.32 $77,058,266.88 43241292
$57,784,005.32 $68,074,955.32 $83,457,058.05 $91,962,414.80 61085564
$14,539,145.93 $70,979,492.10 $130,521,984.18 72013541
$37,829,119.78 $45,242,671.02 $49,841,335.96 $55,074,083.81 39447293
$23,172,796.51 $107,321,944.21 $220,359,536.45 $369,998,622.61 180213225
$205,334,690.66 $265,156,009.82 $406,047,544.41 $582,683,696.71 250889769
$807,775,920.89 $1,282,754,970.54 $1,641,831,319.28 $1,748,346,359.77 936185436
$7,391,803.01 $10,981,809.04 $12,868,092.48 $13,444,219.52 8795349
$20,792,163.75 $57,960,391.56 $81,641,258.07 $93,736,396.03 51165748
$1,586,086.65 1586087
$54,301,981.40 $68,613,182.43 $72,398,822.77 $75,233,732.20 52561847
$14,847,251.03 $59,745,271.66 37296261
$446,809,492.15 $600,736,099.99 $665,720,917.07 $645,104,132.63 448921765

$3,098,637.80 $25,466,822.44 14282730
$211,960,092.05 $277,833,978.10 $277,071,588.34 $304,428,715.05 212841336
$3,833,692.54 $26,297,408.36 $52,461,644.90 27530915
$144,894,284.51 $177,010,013.36 $210,388,857.75 $196,579,598.56 147901299
$8,974,380.99 $49,604,736.83 $112,310,172.34 $185,417,236.55 89076632
$86,169,160.40 $143,951,167.37 $228,530,191.00 $334,701,308.37 127529534

Annual Growth
Rate Immunomodulato
28.69% Adalimumab
Medicare D
20.58% Anakinra
Medicare D
127.21% Apremilast
Medicare D
2448.58% Brodalumab
Medicare D
19.63% Certolizumab
Medicare D
281.99% Dupilumab
Medicare D
17.54% Etanercept
Medicare D
717.65% Guselkumab
Medicare D
20.00% Infliximab
Medicare D
199.62% Ixekizumab
Medicare D
16.34% Rituximab
Medicare D
151.81% Secukinumab
Medicare D
50.39% Ustekinumab
Medicare D
36.91% Adalimumab
Medicaid
20.93% Anakinra
Medicaid
172.56% Apremilast
Medicaid
N/A Brodalumab
Medicaid
19.29% Certolizumab
Medicaid
302.40% Dupilumab
Medicaid
19.45% Etanercept
Medicaid
721.87% Guselkumab
Medicaid
16.43% Infliximab
Medicaid
269.92% Ixekizumab
Medicaid
13.41% Rituximab
Medicaid
174.40% Secukinumab
Medicaid
63.01% Ustekinumab
Medicaid
2012 2013 2014 2015 2016 2017 2018

$1,017.27 $1,150.67 $1,328.44 $1,616.41 $1,969.07 $2,237.00 $2,462.41
$100.86 $133.85 $157.17 $173.65 $198.65 $200.61 $212.50
$31.89 $36.37 $42.97 $49.57 $54.81
$1,188.66 $1,192.40
$2,169.67 $2,412.60 $2,778.18 $3,065.20 $3,448.44 $3,819.16 $4,107.98
$719.14 $736.25
$483.05 $570.26 $658.30 $785.48 $964.11 $1,119.38 $1,228.69
$9,766.13 $10,259.39
$644.13 $736.65 $829.47 $801.50 $812.27 $1,005.30 $940.08
$4,357.20 $4,770.81 $5,239.52
$64.65 $66.23 $70.51 $74.23 $78.85 $307.18 $324.70
$2,735.60 $3,036.42 $3,301.50 $3,584.79
$11,823.74 $13,326.35 $14,608.74 $16,212.79 $17,154.78 $18,838.34 $20,561.47
$1,004.81 $1,124.44 $1,300.00 $1,578.75 $1,910.87 $2,158.38 $2,257.89
$98.10 $127.54 $157.16 $168.52 $195.09 $198.12 $193.68
$31.09 $35.77 $42.74 $48.52 $48.08
$1,073.68
$1,946.05 $2,241.29 $2,630.39 $2,350.75 $2,878.20 $3,177.07 $3,180.54
$708.33 $651.61
$487.19 $547.69 $630.58 $751.59 $916.48 $1,046.25 $1,091.42

$9,534.27 $9,318.20
$619.79 $610.86 $684.48 $741.93 $785.30 $679.55 $694.24
$4,265.69 $4,759.47 $4,679.21
$58.90 $62.80 $64.81 $69.16 $70.76 $81.28 $79.47
$2,232.09 $2,982.04 $3,251.66 $3,324.41
$11,686.15 $11,532.53 $15,037.77 $15,419.79 $16,553.34 $16,533.93 $17,274.02

Annual
Mean Growth Rate
1683 15.87%
168 13.22%
43 14.50%
1191 0.31%
3114 11.23%
728 2.38%
830 16.84%
10013 5.05%
824 6.50%
4789 9.66%
141 30.86%
3165 9.43%
16075 9.66%
1619 14.45%
163 12.01%
41 11.51%
1074 N/A
2629 8.53%
680 -8.01%
782 14.39%
9426 -2.27%
688 1.91%
4568 4.74%
70 5.12%
2948 14.20%
14863 6.73%
Chart Title
$23,000.00
$21,000.00
$19,000.00
Axis Title $17,000.00
$15,000.00
$13,000.00
$11,000.00
$9,000.00
2012 2013 2014 2015 2016
Average Medicare Part D vs. Medicaid Spending for Immuno
$6,000.00
$5,000.00
$5,000.00
$4,000.00
Axis Title
$3,000.00
$2,000.00
$1,000.00
$0.00
2012 2013 2014 2015 2016
Chart Title
Guselkumab Medicare D
Guselkumab Medicaid
2014 2015 2016 2017 2018
icaid Spending for Immunomodulators Per Dosage Unit (2012-2018)
Anakinra Medicare D
Adalimumab Medicaid
Anakinra Medicaid
Apremilast Medicaid
Etanercept Medicaid
Infliximab Medicaid
Ixekizumab Medicaid
Rituximab Medicaid
14 2015 2016 2017 2018

Calendar Year 2012
Approval Year
for
Dermatologic
Generic Name Indication Utilization Total Spending Total Claims
Adalimumab $265,527,469.84 114,272
Anakinra $4,299,194.25 2,275
Apremilast
Brodalumab
Certolizumab PEGol $26,113,373.14 11,232
Dupilumab
Etanercept $222,125,192.24 104,737
Guselkumab
Infliximab $122,215,650.65 42,291
Ixekizumab
Rituximab 92,411,514 22,739
Secukinumab
Ustekinumab $17,836,114.63 1,975
Calendar Year 2012 Calendar Year 2013
Average Average
Spending Per Average Spending Per
Total Dosage Dosage Unit Spending Per Total Dosage Dosage Unit
Units (Weighted) Claim Total Spending Total Claims Units (Weighted)
264,249 $1,004.81 $2,323.64 $332,779,406.13 127,339 296,547 $1,124.44
43,826 $98.10 $1,889.76 $5,649,574.47 2,259 44,297 $127.54
13,595 $1,946.05 $2,324.91 $31,080,599.40 12,057 13,865 $2,241.29
466,419 $487.19 $2,120.79 $255,804,307.86 108,076 470,399 $547.69
197,190 $619.79 $2,889.87 $129,283,305.35 42,768 211,643 $610.86
1,568,947 $58.90 $4,064.01 $97,561,822.54 23,152 1,553,557 $62.80
1,514 $11,686.15 $9,030.94 $29,799,659.34 2,918 2,714 $11,532.53

Calendar Year 2014
Average
Spending Per Total Dosage Dosage Unit Spending Per
Claim Total Spending Total Claims Units (Weighted) Claim
$4,034.70 $474,282,605.92 157,885 366,150 $1,300.00 $4,656.76
$2,500.92 $6,932,749.83 2,234 44,114 $157.16 $3,103.29
$1,698,531.04 992 54,686 $31.09 $1,712.23
$2,577.81 $40,191,238.86 12,756 15,230 $2,630.39 $3,150.77
$2,338.80 $306,152,210.01 113,024 483,550 $630.58 $2,657.84
$3,022.90 $167,096,025.71 52,191 244,119 $684.48 $3,201.63
$4,213.97 $116,462,999.88 25,689 1,796,990 $64.81 $4,533.57
$10,212.36 $51,719,138.20 4,727 3,413 $15,037.77 $10,941.22

Calendar Year 2015 Calendar Y
Average
Total Dosage Dosage Unit Spending Per
Total Spending Total Claims Units (Weighted) Claim Total Spending
$807,775,920.89 221,184 512,630 $1,578.75 $5,418.56 $1,282,754,970.54
$7,391,803.01 2,186 43,864 $168.52 $3,381.43 $10,981,809.04
$20,792,163.75 9,968 581,810 $35.77 $2,085.89 $57,960,391.56
$54,301,981.40 15,728 25,109 $2,350.75 $3,452.57 $68,613,182.43
$446,809,492.15 140,976 590,110 $751.59 $3,105.29 $600,736,099.99
$211,960,092.05 59,526 285,686 $741.93 $3,560.80 $277,833,978.10

$3,833,692.54
$144,894,284.51 30,576 2,095,058 $69.16 $4,738.82 $177,010,013.36
$8,974,380.99 $1,522.00 $4,813.00 $2,232.09 $7,237.59 $49,604,736.83
$86,169,160.40 7,246 5,529 $15,419.79 $11,891.96 $143,951,167.37
Average
Total Dosage Dosage Unit Spending Per Total Dosage
Total Claims Units (Weighted) Claim Total Spending Total Claims Units
282,454 669,094 $1,910.87 $6,686.81 $1,641,831,319.28 321,169 762,854
2,732 56,291 $195.09 $4,019.70 $12,868,092.48 3,127 64,949
23,023 1,356,230 $42.74 $2,517.50 $81,641,258.07 28,585 1,682,823
18,706 31,205 $2,878.20 $3,667.98 $72,398,822.77 18,289 27,599

$14,847,251.03 5,120 20,961
155,246 647,094 $916.48 $3,782.50 $665,720,917.07 151,885 625,757
$3,098,637.80 298 325
71,909 353,795 $785.30 $3,863.69 $277,071,588.34 68,251 326,333
433 892 $4,265.69 $9,656.25 $26,297,408.36 3,602 5,542
35,579 2,501,586 $70.76 $4,975.13 $210,388,857.75 36,806 2,588,515
$8,513.00 $22,531.00 $2,982.04 $6,499.29 $112,310,172.34 $19,467.00 $45,614.00
11,088 12,178 $16,553.34 $12,982.61 $228,530,191.00 16,424 44,660
Year 2017 Calendar Year 2018
Average Average
Spending Per Average Spending Per Average
Dosage Unit Spending Per Total Dosage Dosage Unit Spending Per
(Weighted) Claim Total Spending Total Claims Units (Weighted) Claim
$2,158.38 $7,573.10 $1,748,346,359.77 326,989 785,119 $2,257.89 $8,102.84
$198.12 $4,115.16 $13,444,219.52 3,252 69,414 $193.68 $4,134.14
$48.52 $2,856.09 $93,736,396.03 32,911 1,950,422 $48.08 $2,848.18
$1,586,086.65 471 1,477 $1,073.68 $3,367.49
$3,177.07 $3,958.60 $75,233,732.20 18,697 25,885 $3,180.54 $4,023.84
$708.33 $2,899.85 $59,745,271.66 22,628 91,715 $651.61 $2,640.32
$1,046.25 $4,272.58 $645,104,132.63 142,125 580,702 $1,091.42 $4,416.58
$9,534.27 $10,398.11 $25,466,822.44 2,678 2,733 $9,318.20 $9,509.64
$679.55 $3,021.72 $304,428,715.05 69,517 337,780 $694.24 $3,437.03
$4,759.47 $9,323.76 $52,461,644.90 7,912 11,074 $4,679.21 $8,720.04
$81.28 $5,716.16 $196,579,598.56 33,467 2,473,769 $79.47 $5,873.83
$3,251.66 $6,086.41 $185,417,236.55 $32,928.00 $76,702.00 $3,324.41 $5,969.61
$16,533.93 $13,914.41 $334,701,308.37 22,272 79,825 $17,274.02 $15,027.90
Medicaid Avg. Spending Per Dosage Uni
Biologics 2012
$1,004.81
Adalimumab
Medicaid
Anakinra
Medicaid
Apremilast
Medicaid
Brodalumab
Medicaid
Certolizumab
Medicaid
$487.19
Etanercept
Medicaid
Guselkumab
Medicaid
$619.79
Infliximab
Medicaid
Ixekizumab
Medicaid
Rituximab
Medicaid
Secukinumab
Medicaid
Ustekinumab
Medicaid
dicaid Avg. Spending Per Dosage Unit (USD)
2013 2014 2015 2016 2017 2018 Mean
$1,124.44 $1,300.00 $1,578.75 $1,910.87 $2,158.38 $2,257.89 1619
$127.54 $157.16 $168.52 $195.09 $198.12 $193.68 173
$31.09 $35.77 $42.74 $48.52 $48.08 41
$1,073.68 1074
$2,241.29 $2,630.39 $2,350.75 $2,878.20 $3,177.07 $3,180.54 2743
$547.69 $630.58 $751.59 $916.48 $1,046.25 $1,091.42 782
$9,534.27 $9,318.20 9426
$610.86 $684.48 $741.93 $785.30 $679.55 $694.24 688

$4,265.69 $4,759.47 $4,679.21 4568
$62.80 $64.81 $69.16 $70.76 $81.28 $79.47 71
$2,232.09 $2,982.04 $3,251.66 $3,324.41 2948
$11,532.53 $15,037.77 $15,419.79 $16,553.34 $16,533.93 $17,274.02 15392

Annual Growth Annual
Rate Mean % Change Growth Rate
14.45% Adalimumab 1619 124.71% 14.45%
8.71% Anakinra 173 51.86% 8.71%
11.51% Apremilast 41 54.63% 11.51%
N/A Brodalumab 1074 N/A N/A
7.25% Certolizumab 2743 41.91% 7.25%
14.39% Etanercept 782 55.36% 14.39%
-2.27% Guselkumab 9426 -2.27% -2.27%
1.91% Infliximab 688 12.01% 1.91%

4.74% Ixekizumab 4568 9.69% 4.74%
4.82% Rituximab 71 26.54% 4.82%
14.20% Secukinumab 2948 48.94% 14.20%
8.42% Ustekinumab 15392 49.79% 8.42%
Mean and Annual Growth Rate for Averagage Medicaid Spending Per Dosage
Unit for Biologic Medications
Mean Medicaid Spending Per Dosage Unit (USD)
18000 16.00%
16000 14.00%
14000 12.00%
12000 10.00%
8.00%
Annual Growth Rate

10000
6.00%
8000
4.00%
6000 2.00%
4000 0.00%
2000 -2.00%
0 -4.00%
ab ra t
as m a
b ab pt ab ab ab ab ab ab
um kin mil u um rce um i m um xim um um
a l z e k x
im An re da toli an el fli kiz tu ukin ekin
al Ap Bro r Et Gus In Ixe Ri c t
Ad Ce Se Us
Mean Annual Growth Rate

Per Dosage
16.00%
14.00%
12.00%
10.00%
8.00%
Annual Growth Rate
6.00%
4.00%
2.00%
0.00%
-2.00%
-4.00%
Drug Description
Injection, adalimumab, 20 mg
Injection, certolizumab pegol, 1 mg
Injection, etanercept, 25 mg
Injection, infliximab, excludes biosimilar, 10 mg
Intravenous Injection, infliximab-abda, biosimilar, (renflexis), 10 mg
Intravenous Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg
Injection, rituximab, 100 mg
Ustekinumab, for subcutaneous injection, 1 mg
Ustekinumab, for intravenous injection, 1 mg
HCPCS Code Standard Dosing Lookup
J0135 160mg, 80mg, 40mg
J0717 400mg, 200mg
J1438 25mg, 50mg
J1745 5mg/kg
Q5104 5mg/kg
Q5103 5mg/kg
J9310 375mg/m2
J3357 45mg, 90mg
J3358 only for Crohns and Ulcerative Colitis
source: https://www.drugs.com
Calendar Year 2012
Total Dosage
Brand Name Generic Name Total Spending Units Total Claims
$180,256.55 395 148
Cimzia Certolizumab Pegol $37,992,563.90 8,336,876 22,027
$194,386.91 879 172
Remicade Infliximab $1,003,041,902 15,805,038 341,475
Renflexis Infliximab-Abda
Inflectra Infliximab-Dyyb
Rituxan Rituximab $1,422,574,939.10 2,314,226 277,588
Stelara Ustekinumab $9,219,535.99 73,987 1,385
Stelara (J3358) Ustekinumab
Calendar Year 2012 Ca
Average Average
Spending Per Spending Per Average Spending
Total Beneficiaries Dosage Unit Claim Per Beneficiary Total Spending
34 $456.35 $954.68 $5,301.66 $264,643
3,384 $4.56 $2,258.40 $11,227.12 $68,496,659.75
31 $221.15 $1,254.79 $6,270.55 $218,989.43
59,360 $63.46 $3,380.84 $16,897.61 $1,096,908,345
68,394 $614.71 $4,044.44 $20,799.70 $1,504,047,829

523 $124.61 $2,563.67 $17,628.18 $15,280,891
Calendar Year 2013
Average Average Average

Total Dosage Total Spending Per Spending Per Spending Per
Units Total Claims Beneficiaries Dosage Unit Claim Beneficiary Total Spending
532 204 28 $497.45 $1,923.96 $9,451.54 $202,726
13,752,424 36,342 5,586 $4.98 $2,499.52 $12,262.20 $118,374,166
896 213 29 $244.41 $1,532.11 $7,551.36 $209,333
16,346,163 347,384 60,026 $67.10 $3,157.62 $18,273.89 $1,171,820,499
2,262,322 278,743 69,892 $664.82 $5,395.82 $21,519.60 $1,500,088,460

116,296 2,068 735 $131.40 $7,389.21 $20,790.33 $21,309,186
Calendar Year 2014

359 153 38 $564.70 $1,087.93 $5,334.90 $166,970
19,853,977 52,580 7,463 $5.96 $2,251.32 $15,861.47 $174,777,119
775 232 41 $270.11 $1,041.10 $5,105.68 $206,938
16,576,220 347,520 59,715 $70.69 $3,371.95 $19,623.55 $1,242,339,355
2,179,941 267,627 68,665 $688.13 $5,605.15 $21,846.48 $1,560,999,014

142,999 2,453 904 $149.02 $8,686.99 $23,572.11 $31,321,560
Calendar Year 2015

260 124 27 $642.19 $1,263.54 $6,184.08
28,253,509 74,155 9,982 $6.19 $2,356.92 $17,509.23 $235,096,751
674 199 26 $307.03 $1,625.96 $7,959.15
16,519,598 341,071 58,683 $75.20 $3,642.47 $21,170.34 $1,336,041,105
2,154,383 261,544 68,544 $724.57 $5,968.40 $22,773.68 $1,663,513,650

197,699 3,448 1,217 $158.43 $9,083.98 $25,736.70 $46,057,201
Calendar Year 2016

35,354,748 92,435 11,946 $6.65 $2,543.37 $19,679.96 $305,139,039
16,663,532 339,552 58,352 $80.18 $3,934.72 $22,896.24 $1,341,011,663
2,172,976 261,190 69,861 $765.55 $6,368.98 $23,811.76 $1,753,455,037

288,954 4,944 1,739 $159.39 $9,315.78 $26,484.88 $92,959,948
Calendar Year 2017

Total Dosage Total Spending Per Spending Per Spending Per Average Sales
Units Total Claims Beneficiaries Dosage Unit Claim Beneficiary Price
41,635,860 108,041 13,802 $7.33 $2,824.29 $22,108.32 $7.50
16,046,309 322,216 56,429 $83.57 $4,161.84 $23,764.58 $85.17
2,154,865 258,813 70,402 $813.72 $6,774.99 $24,906.32 $831.90

563,130 8,494 3,109 $165.08 $10,944.19 $29,900.27 $179.47
Calendar Year 2018
Average
Total Dosage Total Total Dosage Unit Spending Per Spending Per
Total Spending Units Claims Beneficiaries (Weighted) Claim Beneficiary
$366,371,065 47,813,843 123,583 15,612 $7.66 $2,964.57 $23,467.27
$1,149,653,207 14,999,597 296,606 52,085 $76.65 $3,876.03 $22,072.64

$6,527,098 98,817 2,086 716 $66.05 $3,129.00 $9,116.06
$65,048,865 1,021,568 21,514 5,510 $63.68 $3,023.56 $11,805.60
$1,699,302,442 2,091,194 249,835 70,845 $812.60 $6,801.70 $23,986.20
$153,223,417 933,938 13,506 4,256 $164.06 $11,344.84 $36,001.74
$8,213,622 666,923 1,821 1,692 $12.32 $4,510.50 $4,854.39
Average Sales
Price
$7.95
$82.96
$67.99
$65.35
$899.17
$189.66
$12.62
Medicaid Medicare Part B Medicare Part D
Adalimumab Adalimumab Adalimumab
Anakinra Anakinra Anakinra
Apremilast Apremilast Apremilast
Brodalumab Brodalumab Brodalumab
Certolizumab Certolizumab Certolizumab
Etanercept Etanercept Etanercept
Guselkumab Guselkumab Guselkumab
Infliximab Infliximab Infliximab
Ixekizumab Ixekizumab Ixekizumab
Risankizumab Risankizumab Risankizumab
Rituximab Rituximab Rituximab
Secukimumab Secukimumab Secukimumab
Ustekimumab Ustekimumab Ustekimumab
Calendar Year 2013
Total Dosage Total

Brand Name Generic Name Total Spending Units Claims
Humira Adalimumab $292,599,225.19 254,465 99,800
Humira Pen Adalimumab $636,208,831.67 551,118 220,856
Humira Pen Crohn-Uc-Hs StarAdalimumab $16,382,486.93 14,284 2,387
Humira Pen Psoriasis-Uveitis Adalimumab $10,141,266.91 8,807 2,199
Adalimumab Total Adalimumab $955,331,810.70 828,674 325,242
Kineret Anakinra $1,004,994.19 7,508 393
Otezla Apremilast
Siliq Brodalumab
Cimzia Certolizumab PEGol $76,965,425.43 31,903 26,930
Dupilumab Dupixent
Enbrel Etanercept $424,865,336.64 822,312 157,908
Embrel Mini Etanercept
Enbrel Sureclick Etanercept $552,090,142.00 929,096 196,344
Etanercept Total Etanercept $976,955,478.64 1,751,408 354,252
Tremfya Guselkumab
Remicade Infliximab $42,902,833.37 58,240 10,327
Renflexis Infliximab-Abda
Inflectra Infliximab-Dyyb
Infliximab Total Infliximab
Taltz Autoinjector Ixekizumab
Taltz Autoinjector (2 Pack) Ixekizumab
Taltz Autoinjector (3 Pack) Ixekizumab
Taltz Syringe Ixekizumab
Ixekizumab Total Ixekizumab
Rituxan Rituximab $30,301,486.67 457,516 3,774
Rituxan Hycela Rituximab/Hyaluronidase,Human
Rituximab Total Rituximab $30,301,486.67 457,516 3,774
Cosentyx (2 Syringes) Secukinumab
Cosentyx Pen Secukinumab
Cosentyx Pen (2 Pens) Secukinumab
Cosentyx Syringe Secukinumab
Secukinumab Total Secukinumab
Stelara* Ustekinumab $89,501,701.78 6,714 9,001
Average
Total Dosage Unit Spending Per Spending Per Total Dosage Total
Beneficiaries (Weighted) Claim Beneficiary Total Spending Units Claims
15,713 $1,149.86 $2,931.86 $18,621.47 $333,995,362.71 252,036 98,025
34,029 $1,154.40 $2,880.65 $18,696.08 $871,312,974.37 653,087 259,109
2,129 $1,146.94 $6,863.21 $7,694.92 $21,764,649.08 16,433 2,767
1,709 $1,151.50 $4,611.76 $5,934.04 $12,780,898.05 9,610 2,400
53,580 $1,150.67 $4,321.87 $12,736.63 $1,239,853,884.21 931,166 362,301
88 $133.85 $2,557.24 $11,420.39 $8,004,714.44 50,929 2,234
$11,941,418.73 374,490 6,148
4,396 $2,412.60 $2,857.98 $17,508.06 $109,925,510.93 39,597 30,735
23,384 $546.30 $2,690.59 $18,169.06 $478,824,482.27 798,995 154,177
30,591 $594.22 $2,811.85 $18,047.47 $719,573,305.51 1,050,501 221,123

53,975 $570.26 $2,751.22 $18,108.27 $1,198,397,787.78 1,849,495 375,300
2,157 $736.65 $4,154.43 $19,890.05 $52,615,463.95 63,433 11,346
1,326 $66.23 $8,029.01 $22,851.80 $35,629,300.64 505,329 4,111
1,326 $66.23 $8,029.01 $22,851.80 $35,629,300.64 505,329 4,111
3,037 $13,326.35 $9,943.53 $29,470.43 $157,144,756.23 10,830 14,073

Average
15,447 $1,325.19 $3,407.25 $21,622.02 $402,044,782.67 249,364 97,905
39,233 $1,334.14 $3,362.73 $22,208.68 $1,211,645,971.10 747,594 297,085
2,489 $1,324.43 $7,865.79 $8,744.33 $29,262,636.87 18,212 3,061
1,972 $1,329.99 $5,325.37 $6,481.19 $19,228,790.53 11,827 2,963
59,141 $1,328.44 $4,990.29 $14,764.05 $1,662,182,181.17 1,026,996 401,014
394 $157.17 $3,583.13 $20,316.53 $8,767,048.38 50,486 2,336
2,212 $31.89 $1,942.33 $5,398.47 $75,763,880.81 2,085,780 33,283
4,999 $2,778.18 $3,576.56 $21,989.50 $131,546,210.96 42,917 33,666
22,753 $631.61 $3,105.68 $21,044.45 $528,682,160.74 738,396 142,720
34,043 $684.98 $3,254.18 $21,137.19 $856,461,493.92 1,045,534 222,934

56,796 $658.30 $3,179.93 $21,090.82 $1,385,143,654.66 1,783,930 365,654
2,338 $829.47 $4,637.36 $22,504.48 $57,784,005.32 72,095 11,286
1,559 $70.51 $8,666.82 $22,853.95 $37,829,119.78 509,622 4,138
1,559 $70.51 $8,666.82 $22,853.95 $37,829,119.78 509,622 4,138

$3,017,190.29 1,668 446
$990,963.09 274 88
$18,935,975.67 10,355 3,036
$228,667.46 62 23
$23,172,796.51 12,359 3,593
4,543 $14,608.74 $11,166.40 $34,590.53 $205,334,690.66 12,660 16,956
Average
15,452 $1,612.27 $4,106.48 $26,018.95 $490,135,622.39 249,431 100,135
44,278 $1,620.73 $4,078.45 $27,364.51 $1,638,715,582.70 829,513 340,100
2,785 $1,606.81 $9,559.83 $10,507.23 $40,579,690.39 20,679 3,458
2,418 $1,625.84 $6,489.64 $7,952.35 $28,557,998.94 14,472 3,634
64,933 $1,616.41 $6,058.60 $17,960.76 $2,197,988,894.42 1,114,095 447,327
398 $173.65 $3,753.02 $22,027.76 $10,858,650.70 54,662 2,455
8,024 $36.37 $2,276.35 $9,442.16 $162,941,986.97 3,792,918 60,290
5,536 $3,065.20 $3,907.39 $23,761.96 $160,787,675.01 46,627 37,957
20,544 $751.81 $3,704.33 $25,734.14 $572,976,596.14 645,183 127,865
33,171 $819.16 $3,841.77 $25,819.59 $999,159,619.88 1,004,159 216,642

53,715 $785.48 $3,773.05 $25,776.86 $1,572,136,216.02 1,649,342 344,507
2,296 $801.50 $5,119.97 $25,167.25 $68,074,955.32 83,808 12,097
$7,811,745.51 1,794 1,017

$3,515,394.77 807 392
$2,365,552.60 546 179
$846,453.05 193 105
$14,539,145.93 $3,340.00 $1,693.00
1,580 $74.23 $9,141.88 $23,942.48 $45,242,671.02 573,781 4,868
1,580 $74.23 $9,141.88 $23,942.48 $45,242,671.02 573,781 4,868

137 $1,808.87 $6,765.00 $22,023.29 $11,921,386.75 5,907 1,962
31 $3,616.65 $11,260.94 $31,966.55 $16,357,720.40 4,041 2,069
839 $1,828.68 $6,237.15 $22,569.70 $75,108,682.84 37,346 12,847
$3,688.18 $9,942.06 $3,934,154.22 967 471
1,007 $2,735.60 $8,551.29 $25,519.84 $107,321,944.21 48,261 17,349
5,644 $16,212.79 $12,109.85 $36,381.06 $265,156,009.82 20,521 20,214
Average
15,477 $1,965.01 $4,894.75 $31,668.65 $544,274,923.74 244203.4 99060
48,164 $1,975.51 $4,818.33 $34,023.66 $2,015,734,946.20 901506.14 370804
3,272 $1,962.36 $11,735.02 $12,402.11 $43,076,899.94 19247 3229
2,827 $1,973.38 $7,858.56 $10,101.87 $35,449,849.79 15789.4 3947
69,740 $1,969.07 $7,326.66 $22,049.07 $2,638,536,619.67 1180745.94 477040
388 $198.65 $4,423.08 $27,986.21 $11,899,227.85 59315.48 2720
11,661 $42.97 $2,702.64 $13,973.24 $243,149,800.87 4906678 77263
$123,026.25 103.5 29
5,903 $3,448.44 $4,236.05 $27,238.30 $164,587,668.71 43096.5 34528
$26,650,729.76 1984 8377
18,423 $933.19 $4,481.11 $31,101.16 $603,124,725.77 592975 119782
$112,942.57 98 20
31,683 $995.02 $4,612.03 $31,536.14 $1,157,839,006.00 1016421.66 224688
50,106 $964.11 $4,546.57 $31,318.65 $1,761,076,674.34 1609494.66 344490
$9,424,317.32 965 876
2,407 $812.27 $5,627.42 $28,282.08 $83,155,787.06 79813.67 13328
$301,270.99 311 51
$83,457,058.05 80124.67 13379
314 $4,354.37 $7,681.17 $24,878.17 $41,272,125.67 8623 6673
189 $4,356.13 $8,967.84 $18,599.97 $15,017,389.56 3161 1496
178 $4,332.51 $13,215.38 $13,289.62 $8,763,216.44 1840 611
37 $4,385.77 $8,061.46 $22,877.11 $5,926,760.43 1239 846
$718.00 $4,357.20 $9,481.46 $19,911.22 $70,979,492.10 14863 9626
1,756 $78.85 $9,293.89 $25,764.62 $49,742,407.36 579105 4959
$98,928.60 187.2 14
1,756 $78.85 $9,293.89 $25,764.62 $49,841,335.96 579292.2 4973
461 $2,018.18 $6,076.14 $25,859.84 $21,463,128.55 9698 3431
679 $4,047.94 $7,906.10 $24,090.90 $42,055,138.46 9573 6136
2,442 $2,011.16 $5,846.40 $30,757.04 $145,528,978.80 66519 24755
174 $4,068.41 $8,352.77 $22,610.08 $11,312,290.64 2564 1529
3,756 $3,036.42 $7,045.35 $25,829.46 $220,359,536.45 88,354 35,851
6,663 $17,154.78 $13,117.44 $39,795.29 $406,047,544.41 46481 27365
Average
14967 $2,228.76 $5,494.40 $36,365.00 $596,366,042.85 243,722 97,867
51835 $2,235.96 $5,436.12 $38,887.53 $2,388,794,496.60 971,914 394,616
3043 $2,238.11 $13,340.63 $14,156.06 $41,116,714.32 16,632 2,779
3177 $2,245.17 $8,981.47 $11,158.28 $37,593,195.31 15,203 3,792
73022 $2,237.00 $8,313.15 $25,141.72 $3,063,870,449.08 1,247,471 499,054
414 $200.61 $4,374.72 $28,742.10 $13,197,063.41 62,105 2,912
13820 $49.57 $3,147.04 $17,594.05 $318,273,429.22 5,809,157 91,021
11 $1,188.66 $4,242.28 $11,184.20 $3,135,421.24 2,630 754
5346 $3,819.16 $4,766.79 $30,787.07 $164,604,113.84 40,071 32,056
37059 $719.14 $3,181.42 $13,432.83 $101,803,038.04 5,220 32,059
16880 $1,066.53 $5,035.19 $35,730.14 $611,605,535.46 543,772 109,207
19 $1,152.48 $5,647.13 $5,944.35 $45,597,783.46 36,269 8,123
32005 $1,139.13 $5,153.10 $36,176.82 $1,247,769,463.30 996,244 218,062
48904 $1,119.38 $5,278.47 $25,950.43 $1,904,972,782.22 1,576,285 335,392
495 $9,766.13 $10,758.35 $19,039.02 $77,058,266.88 7,511 7,301
2642 $1,041.87 $6,239.18 $31,474.56 $90,852,542.21 84,541 14,144
$41,260.75 53 13
19 $968.72 $5,907.27 $15,856.37 $1,068,611.84 1,105 187
2661 $1,005.30 $6,073.23 $23,665.46 $91,962,414.80 85,699 14,344
1215 $4,786.28 $6,184.94 $33,968.83 $81,564,042.48 15,586 13,075
731 $4,750.84 $10,038.36 $20,543.62 $23,615,872.11 4,512 2,175
588 $4,762.62 $14,342.42 $14,903.43 $13,534,303.76 2,586 863
169 $4,783.50 $7,005.63 $35,069.59 $11,807,765.83 2,246 1,601
2703 $4,770.81 $9,392.84 $26,121.37 $130,521,984.18 $24,930.00 $17,714.00
1742 $85.90 $10,030.73 $28,554.77 $54,573,068.93 578,562 4,889
$528.46 $7,066.33 $501,014.88 903 67
1742 $307.18 $8,548.53 $28,554.77 $55,074,083.81 579,465 4,956
802 $2,213.15 $6,255.65 $26,762.01 $33,677,317.92 14,184 5,335
1431 $4,393.10 $6,853.84 $29,388.64 $67,289,102.08 14,083 9,191
4374 $2,187.78 $5,878.77 $33,271.37 $251,724,048.29 105,990 40,928
434 $4,411.97 $7,398.49 $26,065.19 $17,308,154.32 3,597 2,287
7,041 $3,301.50 $6,596.69 $28,871.80 $369,998,622.61 137,854 57,741
8788 $18,838.34 $14,838.21 $46,204.77 $582,683,696.71 53,184 34,048
Calendar Year 2018 Yearly Change Yearly Change
Change in Annual Growth Change in

Average Average Rate in Average Average
Spending Per Average Average Spending Per Spending Per Spending Per
Total Dosage Unit Spending Per Spending Per Dosage Unit Dosage Unit Dosage Unit
Beneficiaries (Weighted) Claim Beneficiary (2016-2017) (2013-2017) (2017-2018)
14,700 $2,446.91 $6,093.64 $40,569.12 13.42% 17.99% 9.79%
53,684 $2,457.83 $6,053.47 $44,497.33 13.18% 17.97% 9.92%
2,628 $2,472.14 $14,795.51 $15,645.63 14.05% 18.19% 10.46%
2,971 $2,472.75 $9,913.82 $12,653.38 13.77% 18.17% 10.14%
73,983 $2,462.41 $9,214.11 $28,341.36
480 $212.50 $4,531.96 $27,493.88 0.96% 10.65% 5.93%
15,945 $54.81 $3,496.70 $19,960.70 15.34% 15.84% 10.58%
169 $1,192.40 $4,158.38 $18,552.79 0.31%
4,936 $4,107.98 $5,134.89 $33,347.67 10.75% 12.17% 7.56%
138,330 $736.25 $3,175.49 $19,502.50 2.38%
15,458 $1,176.36 $5,600.42 $39,565.63 14.29% 18.21% 10.30%
2,146 $1,257.22 $5,613.42 $21,247.80 9.09%
30,839 $1,252.47 $5,722.09 $40,460.76 14.48% 17.67% 9.95%
48,443 $1,228.69 $5,645.31 $33,758.07
1,997 $10,259.39 $10,554.48 $38,587.01 5.05%
2,781 $1,074.65 $6,423.40 $32,669.02 28.27% 9.05% 3.15%
$778.50 $3,173.90
54 $967.07 $5,714.50 $19,789.11 -0.17%
2,835 $940.08 $5,103.93 $26,229.06
2,231 $5,233.16 $6,238.17 $36,559.41 9.92% 9.92% 9.34%
1,116 $5,234.01 $10,857.87 $21,161.18 9.06% 9.06% 10.17%
799 $5,233.68 $15,682.85 $16,939.05 9.93% 9.93% 9.89%
305 $5,257.24 $7,375.24 $38,713.99 9.07% 9.07% 9.90%
$4,451.00 $5,239.52 $10,038.53 $28,343.41
1,824 $94.33 $11,162.42 $29,919.45 8.93% 6.72% 9.81%
28 $555.08 $7,477.83 $17,893.39 5.04%
1,852 $324.70 $9,320.13 $23,906.42
1,106 $2,374.32 $6,312.52 $30,449.65 9.66% 10.61% 7.28%
2,055 $4,778.04 $7,321.19 $32,744.09 8.53% 10.21% 8.76%
6,809 $2,374.98 $6,150.41 $36,969.31 8.78% 9.38% 8.56%
559 $4,811.83 $7,568.06 $30,962.71 8.44% 9.37% 9.06%
10,529 $3,584.79 $6,838.05 $32,781.44
9,817 $20,561.47 $17,113.60 $59,354.56 9.81% 9.04% 9.15%
Yearly Change
Annual Growth
Rate in Average
Spending Per
Dosage Unit
(2014-2018)
16.57%
16.50%
16.89%
16.77%
7.83%
14.50%
0.31%
10.27%
2.38%
16.82%
9.09%
16.28%
5.05%
6.69%
-0.17%
9.63%
9.61%
9.91%
9.49%
7.55%
5.04%
9.49%
9.73%
9.10%
9.27%
8.92%
Medicare Part D Avg. Spending Per Dosage Unit (US
Biologics 2012 2013
Adalimumab $1,017.27 $1,150.67
Anakinra $133.85
Apremilast
Brodalumab
Certolizumab $2,412.60
Etanercept $483.05 $570.26
Guselkumab
Infliximab $736.65
Ixekizumab
Rituximab $66.23
Secukinumab
Ustekinumab $13,326.35
g. Spending Per Dosage Unit (USD)
2014 2015 2016 2017 2018 Mean % Change
$1,328.44 $1,616.41 $1,969.07 $2,237.00 $2,462.41 1683 142.06%
$157.17 $173.65 $198.65 $200.61 $212.50 179 58.76%
$31.89 $36.37 $42.97 $49.57 $54.81 43 71.87%
$1,188.66 $1,192.40 1191 0.31%
$2,778.18 $3,065.20 $3,448.44 $3,819.16 $4,107.98 3272 70.27%
$658.30 $785.48 $964.11 $1,119.38 $1,228.69 830 154.36%
$9,766.13 $10,259.39 10013 5.05%
$829.47 $801.50 $812.27 $1,005.30 $940.08 854 27.62%
$4,357.20 $4,770.81 $5,239.52 4789 20.25%
$70.51 $74.23 $78.85 $307.18 $324.70 154 390.26%
$2,735.60 $3,036.42 $3,301.50 $3,584.79 3165 31.04%
$14,608.74 $16,212.79 $17,154.78 $18,838.34 $20,561.47 16784 54.29%
Number of
Manufacturer
Generic Name Brand Name Generic Name s
Adalimumab Humira Adalimumab 1
Adalimumab Humira Pediatric Crohn's Adalimumab 1
Adalimumab Humira Pen Adalimumab 1
Adalimumab Humira Pen Crohn-Uc-Hs Start Adalimumab 1
Adalimumab Humira Pen Psoriasis-Uveitis Adalimumab 1
Adalimumab Adalimumab Total Adalimumab
Anakinra Kineret Anakinra 1
Apremilast Otezla Apremilast 1
Brodalumab Siliq Brodalumab 1
Certolizumab PEGol Cimzia Certolizumab PEGol 1
Dupilumab Dupixent Dupilumab 1
Etanercept Enbrel Etanercept 1
Etanercept Embrel-Mini Etanercept 1
Etanercept Enbrel Sureclick Etanercept 1
Etanercept Etanercept Total Etanercept
Guselkumab Tremfya Guselkumab 1
Infliximab Remicade Infliximab 1
Infliximab-Abda Renflexis Infliximab-Abda 1
Infliximab-Dyyb Inflectra Infliximab-Dyyb 1
Infliximab Infliximab Total Infliximab
Ixekizumab Taltz Autoinjector Ixekizumab 1
Ixekizumab Taltz Autoinjector (2 Pack) Ixekizumab 1
Ixekizumab Taltz Autoinjector (3 Pack) Ixekizumab 1
Ixekizumab Taltz Syringe Ixekizumab 1
Ixekizumab Ixekizumab Ixekizumab
Rituximab Rituxan Rituximab 1
Secukinumab Cosentyx (2 Syringes) Secukinumab 1
Secukinumab Cosentyx Pen Secukinumab 1
Secukinumab Cosentyx Pen (2 Pens) Secukinumab 1
Secukinumab Cosentyx Syringe Secukinumab 1
Secukinumab Secukinumab Secukinumab
Ustekinumab Stelara Ustekinumab 1
Medicaid Avg. Spending Per Dosage Unit (USD)

Biologics 2012 2013 2014
Adalimumab $1,004.81 $1,124.44 $1,300.00
Anakinra $127.54 $157.16
Apremilast $31.09
Brodalumab
Certolizumab $2,241.29 $2,630.39
Etanercept $487.19 $547.69 $630.58
Guselkumab
Infliximab $619.79 $610.86 $684.48
Ixekizumab
Rituximab $62.80 $64.81
Secukinumab
Ustekinumab $11,532.53 $15,037.77
Calendar Year 2013 Calendar Yea
Average
Total Dosage Dosage Unit Spending Per
Total Spending Units Total Claims (Weighted) Claim Total Spending
$80,237,251.27 71,987 31,501 $1,114.61 $2,547.13 $97,176,581.29
$230,762,668.43 205,291 92,059 $1,124.08 $2,506.68 $343,078,850.67

$15,071,033.50 13,320 2,274 $1,131.48 $6,627.54 $23,540,027.09
$6,708,452.93 5,949 1,505 $1,127.58 $4,457.44 $10,487,146.87
$332,779,406.13 296,547 127,339 $1,124.44 $4,034.70 $474,282,605.92
$5,649,574.47 44,297 2,259 $127.54 $2,500.92 $6,932,749.83
$1,698,531.04
$31,080,599.40 13,865 12,057 $2,241.29 $2,577.81 $40,191,238.86
$96,416,303.15 196,351 44,108 $513.77 $2,185.91 $102,192,792.43
$159,388,004.71 274,048 63,968 $581.61 $2,491.68 $203,959,417.58

$255,804,307.86 470,399 108,076 $547.69 $2,338.80 $306,152,210.01
$129,283,305.35 211,643 42,768 $610.86 $3,022.90 $167,096,025.71
$129,283,305.35 211,643 42,768 $610.86 $3,022.90 $167,096,025.71
$97,561,822.54 1,553,557 23,152 $62.80 $4,213.97 $116,462,999.88
$29,799,659.34 2,714 2,918 $11,532.53 $10,212.36 $51,719,138.20

2015 2016 2017 2018 Mean % Change
$1,578.75 $1,910.87 $2,158.38 $2,257.89 1619 124.71%
$168.52 $195.09 $198.12 $193.68 173 51.86%
$35.77 $42.74 $48.52 $48.08 41 54.63%
$1,073.68 1074 N/A
$2,350.75 $2,878.20 $3,177.07 $3,180.54 2743 41.91%
$751.59 $916.48 $1,046.25 $1,091.42 782 55.36%
$9,534.27 $9,318.20 9426 -2.27%
$741.93 $785.30 $679.55 $694.24 688 12.01%
$4,265.69 $4,759.47 $4,679.21 4568 9.69%
$69.16 $70.76 $81.28 $79.47 71 26.54%
$2,232.09 $2,982.04 $3,251.66 $3,324.41 2948 48.94%
$15,419.79 $16,553.34 $16,533.93 $17,274.02 15392 49.79%
Average
Total Dosage Dosage Unit Spending Per Total Dosage
Units Total Claims (Weighted) Claim Total Spending Units Total Claims
75,006 32,943 $1,295.59 $2,949.84 $149,427,879.71 93,238 41,494
$167,487.34 107 37
265,106 119,834 $1,294.12 $2,862.95 $599,528,342.49 382,233 172,299
17,975 3,044 $1,309.59 $7,733.25 $39,403,337.61 24,760 4,198
8,063 2,064 $1,300.68 $5,080.98 $19,248,873.74 12,293 3,156
366,150 157,885 $1,300.00 $4,656.76 $807,775,920.89 512,630 221,184
44,114 2,234 $157.16 $3,103.29 $7,391,803.01 43,864 2,186
54,686 992 $31.09 $1,712.23 $20,792,163.75 581,810 9,968
15,230 12,756 $2,630.39 $3,150.77 $54,301,981.40 25,109 15,728
180,839 41,419 $587.39 $2,467.29 $139,601,538.51 206,939 48,078
302,711 71,605 $673.78 $2,848.40 $307,207,953.64 383,170 92,898

483,550 113,024 $630.58 $2,657.84 $446,809,492.15 590,110 140,976
244,119 52,191 $684.48 $3,201.63 $211,960,092.05 285,686 59,526
244,119 52,191 $684.48 $3,201.63 $211,960,092.05 285,686 59,526
1,796,990 25,689 $64.81 $4,533.57 $144,894,284.51 2,095,058 30,576

$939,617.37 540 181
$1,024,587.86 322 94
$7,010,175.76 3,951 1,247
$8,974,380.99 $4,813.00 $1,522.00

3,413 4,727 $15,037.77 $10,941.22 $86,169,160.40 5,529 7,246
Year 2015 Calendar Year 2016
Average Average
Dosage Unit Spending Per Total Dosage Dosage Unit
(Weighted) Claim Total Spending Units Total Claims (Weighted)
$1,602.64 $3,601.19 $222,863,740.38 116,892 50,266 $1,906.67
$1,565.30 $4,526.68 $321,481.10 170 56 $1,891.07
$1,568.49 $3,479.58 $968,237,887.88 504,576 222,728 $1,918.91
$1,591.42 $9,386.22 $60,759,279.12 31,376 5,303 $1,936.50
$1,565.89 $6,099.14 $30,572,582.06 16,081 4,101 $1,901.20
$1,578.75 $5,418.56 $1,282,754,970.54 669,094 282,454 $1,910.87
$168.52 $3,381.43 $10,981,809.04 56,291 2,732 $195.09
$35.77 $2,085.89 $57,960,391.56 1,356,230 23,023 $42.74
$2,350.75 $3,452.57 $68,613,182.43 31,205 18,706 $2,878.20
$701.43 $2,903.65 $171,738,333.43 203,416 48,356 $866.04
$801.75 $3,306.94 $428,997,766.56 443,678 106,890 $966.91

$751.59 $3,105.29 $600,736,099.99 647,094 155,246 $916.48
$741.93 $3,560.80 $277,833,978.10 353,795 71,909 $785.30
$741.93 $3,560.80 $277,833,978.10 353,795 71,909 $785.30

$2,322,491.53 544 287 $4,269.29
$708,856.10 162 73 $4,375.65
$581,396.04 130 46 $4,472.28
$220,948.87 56 27 $3,945.52
$3,833,692.54 892 433 $4,265.69
$69.16 $4,738.82 $177,010,013.36 2,501,586 35,579 $70.76
$1,740.03 $5,191.26 $5,363,219.69 2,669 983 $2,009.45
$3,181.95 $10,899.87 $8,268,286.49 2,055 1,103 $4,023.50
$1,774.28 $5,621.63 $34,175,435.99 17,349 6,188 $1,969.88
$1,797,794.66 458 239 $3,925.32
$2,232.09 $7,237.59 $49,604,736.83 $22,531.00 $8,513.00 $2,982.04
$15,419.79 $11,891.96 $143,951,167.37 12,178 11,088 $16,553.34
Calendar Year 2017
Average
Spending Per Total Dosage Dosage Unit Spending Per
Claim Total Spending Units Total Claims (Weighted) Claim
$4,433.69 $261,979,000.24 122,666 52,795 $2,135.85 $4,962.19
$5,740.73 $464,449.00 218 70 $2,130.50 $6,634.99
$4,347.18 $1,263,696,300.50 587,159 257,683 $2,152.22 $4,904.07
$11,457.53 $75,007,763.79 34,089 5,815 $2,200.34 $12,899.01
$7,454.91 $40,683,805.75 18,723 4,806 $2,172.99 $8,465.21
$6,686.81 $1,641,831,319.28 762,854 321,169 $2,158.38 $7,573.10
$4,019.70 $12,868,092.48 64,949 3,127 $198.12 $4,115.16
$2,517.50 $81,641,258.07 1,682,823 28,585 $48.52 $2,856.09
$3,667.98 $72,398,822.77 27,599 18,289 $3,177.07 $3,958.60

$14,847,251.03 20,961 5,120 $708.33 $2,899.85
$3,551.54 $174,155,507.27 180,302 43,377 $988.99 $4,014.93
$4,013.45 $491,565,409.80 445,456 108,508 $1,103.51 $4,530.22

$3,782.50 $665,720,917.07 625,757 151,885 $1,046.25 $4,272.58
$3,098,637.80 325 298 $9,534.27 $10,398.11
$3,863.69 $273,889,996.05 320,600 67,095 $854.30 $4,082.12
$84,073.22 133 38 $631.18 $2,212.45
$3,097,519.07 5,600 1,118 $553.17 $2,770.59
$3,863.69 $277,071,588.34 326,333 68,251 $679.55 $3,021.72
$8,092.30 $15,881,124.67 3,357 2,585 $4,730.75 $6,143.57
$9,710.36 $5,089,441.87 1,071 522 $4,752.05 $9,749.89
$12,639.04 $3,535,335.35 738 252 $4,790.43 $14,029.11
$8,183.29 $1,791,506.47 376 243 $4,764.64 $7,372.45
$9,656.25 $26,297,408.36 5,542 3,602 $4,759.47 $9,323.76
$4,975.13 $210,388,857.75 2,588,515 36,806 $81.28 $5,716.16
$5,455.97 $10,923,121.72 5,046 1,975 $2,164.71 $5,530.69
$7,496.18 $23,247,051.68 5,337 3,589 $4,355.83 $6,477.31
$5,522.86 $72,640,411.24 33,966 13,093 $2,138.62 $5,548.03
$7,522.15 $5,499,587.70 1,265 810 $4,347.50 $6,789.61
$6,499.29 $112,310,172.34 $45,614.00 $19,467.00 $3,251.66 $6,086.41
$12,982.61 $228,530,191.00 44,660 16,424 $16,533.93 $13,914.41
Calendar Year 2018 Yearly Change
Change in
Average Average
Total Dosage Dosage Unit Spending Per Dosage Unit
Total Spending Units Total Claims (Weighted) Claim (2016-2017)
$255,983,177.72 114,435 49,118 $2,237.07 $5,211.60 12.0%
$606,138.76 263 77 $2,309.10 $7,871.93 12.7%
$1,386,718,665.10 623,938 268,503 $2,222.53 $5,164.63 12.2%
$66,940,725.53 29,649 5,001 $2,257.80 $13,385.47 13.6%
$38,097,652.66 16,835 4,290 $2,262.98 $8,880.57 14.3%
$1,748,346,359.77 785,119 326,989 $2,257.89 $8,102.84
$13,444,219.52 69,414 3,252 $193.68 $4,134.14 1.3%
$93,736,396.03 1,950,422 32,911 $48.08 $2,848.18 13.1%
$1,586,086.65 1,477 471 $1,073.68 $3,367.49
$75,233,732.20 25,885 18,697 $3,180.54 $4,023.84 2.6%
$59,745,271.66 91,715 22,628 $651.61 $2,640.32
$161,677,537.40 159,852 39,003 $1,034.15 $4,145.26 14.0%
$483,426,595.23 420,850 103,122 $1,148.69 $4,687.91 14.2%

$645,104,132.63 580,702 142,125 $1,091.42 $4,416.58
$25,466,822.44 2,733 2,678 $9,318.20 $9,509.64
$289,865,721.55 313,987 65,088 $923.18 $4,453.44 13.8%
$1,484,112.39 2,760 610 $537.68 $2,432.97
$13,078,881.11 21,032 3,819 $621.85 $3,424.69
$304,428,715.05 337,780 69,517 $694.24 $3,437.03
$30,861,640.37 6,426 5,624 $4,802.62 $5,487.49 8.3%
$11,473,867.59 2,463 1,220 $4,658.49 $9,404.81 8.5%
$6,298,499.47 1,353 460 $4,655.21 $13,692.39
$3,827,637.47 832 608 $4,600.53 $6,295.46
$52,461,644.90 11,074 7,912 $4,679.21 $8,720.04
$196,579,598.56 2,473,769 33,467 $79.47 $5,873.83 12.1%
$17,758,039.66 8,330 3,243 $2,131.82 $5,475.81 8.3%
$31,381,217.19 6,934 4,965 $4,525.70 $6,320.49 10.4%
$127,523,182.97 59,491 23,400 $2,143.57 $5,449.71 8.4%
$8,754,796.73 1,947 1,320 $4,496.56 $6,632.42 12.3%
$185,417,236.55 $76,702.00 $32,928.00 $3,324.41 $5,969.61
$334,701,308.37 79,825 22,272 $17,274.02 $15,027.90 7.7%
Yearly Change Yearly Change
Annual Growth Change in Annual Growth

Rate in Average Average Rate in Average
Spending Per Spending Per Spending Per
Dosage Unit Dosage Unit Dosage Unit
(2013-2017) (2017-2018) (2014-2018)
17.7% 4.42% 14.63%
16.7% 6.84% 13.14%
17.6% 2.85% 14.48%
18.1% 2.16% 14.59%
17.8% 3.66% 14.85%
11.6% -2.24% 5.36%

15.9% -0.92% 11.51%
8.8% 0.11% 4.86%

-8.01% -8.01%
17.7% 4.57% 15.19%
17.3% 4.09% 14.27%
-2.27% -2.27%
9.7% 8.06% 7.77%
-14.81% -14.81%
12.41% 12.42%
8.3% 1.52% 6.06%

8.5% -1.97% 3.18%
-2.82% 2.03%
-3.44% 7.98%
6.4% -2.23% 5.23%

10.8% -1.52% 7.00%
16.9% 3.90% 12.46%
9.2% 0.23% 6.51%
12.3% 3.43% 7.03%
11.2% 4.48% 3.53%

Immunomodulators - All Data 2

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Immunomodulators - All Data 2

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Medicare Part D

Approval Year for

RA, JIA, PsA, AS, CD, Pediatric CD, UC, 354.2% (+

Ustekinumab PsO, PsA, CD 2009 $ 250,889,769 1057.0% (+ 51.6%

Certolizumab PsO, CD, RA, PsA, AS 2018 $ 123,508,620 193.2% (+ 20.7%

RA, PV, Non-Hodgkin's Lymphoma,

Anakinra RA; CAPS $ 8,289,419 207.3% (+$8,902,828) 112.3%

Ustekinumab PsO, PsA, CD 2009 $ 16,075 73.9% (+$8,738) 9.7%

CD, Pediatric CD, UC, Pediatric UC,

Anakinra RA; CAPS

RA, PV, Non-Hodgkin's Lymphoma,

PsA; Psoriasis; Oral Ulcers associated $ 43 71.9% (+$23) 14.5%

Percent Change from

$ 448,921,765 190.4% / (+ 20.5%

$ 127,529,534 1776.5% / (+ 63.3%

$ 51,165,748 5418.7% / (+ 339.6%

$ 52,561,847 188.1% / (+ 19.9%

$ 212,841,336 149.1% / (+ 17.1%

$ 1,586,087 N/A N/A

Average Annual Percent Change from Average Annual

$ 14,863 47.8% (+$5,588) 7.2%

$ 2,629 63.4% (+$1,234) 9.1%

$ 1,619 124.7% (+$1,253) 14.6%

$ 1,074 N/A N/A

$ 688 12.0% (+$74) 2.3%

$ 70 34.9% (+$21) 5.3%

$ 41 54.6% (+$17) 11.8%

age Medicare Part D and Medicaid

Percent chage in Total Medicare Part D Spending for the Imm

art D Spending for the Immunomodulators

care Part D and Medicaid Spending for Immunomodulators (2012-2018) $0.00

2013 2014 2015 2016 2017 2018

Average Spending per Dos

2012 2013 2014 2015

Annual Spending Medicare Part D

Average Annual Spending for Medicare

2012 2013 2014 2015 2016 2017 2018

verage Spending per Dose for Medicare Part D

2012 2013 2014 2015 2016 2017 2018

nding for Medicare Part D Average Annua

2015 2016 2017 2018 2012 20

$619.79 $610.86 $684.48 $741.93 $785.30

$98.10 $127.54 $157.16 $168.52 $195.09

Average Spending per Dose for Medicaid

2012 2013 2014 2015 2016 2017 2018

Annual Spending Medicaid

$4,299,194 $5,649,574 $6,932,750 $7,391,803 $10,981,809

Average Annual Spending for Medicaid Part D

2012 2013 2014 2015 2016 2017 2018

2012 Total 2018 Total Difference

### ### ### ### ### $1,748,346,359.77

### ### ### ### ### $13,444,219.52

### ### ### ### $93,736,396.03

### ### ### ### ### $75,233,732.20

### ### ### ### ### $645,104,132.63

### ### ### ### ### $304,428,715.05

### ### $52,461,644.90

### ### ### ### ### $196,579,598.56

### ### ### $185,417,236.55

### ### ### ### ### $334,701,308.37

Adalimumab $1,004.81 $1,124.44 $1,300.00 $1,578.75

Total Spending (USD)

Immunomodulato 2012 2013 2014 2015