About 576,000 Americans spent more than the median household income in 2014, according to a new report from Express Scrips—a 63% increase over 2013. Drivers of this high-cost population include patients taking specialty medications and have multiple comorbidities, prescribers and prescriptions, according to the pharmacy benefit manager.

Express Scripts also reported that nearly 140,000 people had more than $100,000 in prescription drug costs in 2014—nearly three times as many as in the year before. Hepatitis C and cancer medications, as well as compounded therapies, comprise nearly two-thirds of the cost within this patient population. High-cost patients use antidepressants at twice the rate of the general population.

Our Take: It seems that another week doesn’t pass without a PBM making news, either by making headline-grabbing prescription drug data available, or by adding another high-profile drug to its exception list. The public back-and-forth between payers and drug manufacturers will intensify as more costly treatments become available.

For example, in one recent estimate, hepatitis C treatments will increase Medicare Part D spending by between $2.9 billion and $5.8 billion in 2015. But that analysis was conducted by the Milliman consulting firm on behalf of the Pharmaceutical Care Management Association, a trade group for pharmacy benefit managers. That same study projected a $17 to $33 annual increase in per-beneficiary premiums. Yet according to CMS, premiums will increase this year by about $1/month per beneficiary.

The war of words is underway.

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