Short overview report from Express Scripts for healthcare leaders and managers interested in 2018 drug trends for cost and utilization. Costs went up 0.4% for commercial plans in 2018, driven by specialty brand drugs for inflammatory conditions. Medicare spending declined by 0.3%; Medicare drug spending was led by specialty brand oncology drugs. Medicaid spending went up by 8.2%, with greatest spending on the HIV specialty brand drugs. Lower spending on opioids helped to reduce overall drug costs.