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High-cost cancer treatments save lives but threaten drug benefits

In small town Alberta, four girls, ages five to 15, lose their mom to metastatic breast cancer. On the coast of Prince Edward Island, retired parents remortgage their house for the largest amount of money their bank will give them to pay for their 30-year-old daughter’s colon cancer treatments. A 26-year-old Vancouver man learns he has multiple myeloma just a few months after he gets his first real career job. He dies eight years later, after spending most of his adult life fighting the disease.

Globally, about 8.2 million people die of cancer each year. Almost half of these deaths are premature, taking people in the prime of their lives.

If it hasn’t happened to your family, it has happened to someone you know. Cancer is a deadly, devastating scourge: about two in five Canadians will develop the disease in our lifetime; one in four of us will die of it.

Each February 4, World Cancer Day aims to focus global attention on the need for research as well as on the importance of delivering the best cancer treatment and care possible.

Over the past 20 years, researchers have made huge strides in treatment. For example, two new drugs that help strengthen the immune system are producing remarkable results in the treatment of patients with some of the most dreaded forms of cancer. In trials, KEYTRUDA® extended the lives of many people with advanced melanoma by at least three years, and OPDIVO™ extended the lives of people with advanced lung cancer by two years. The side effects of these drugs are much less disabling than those of traditional chemotherapies, meaning that they significantly enhance quality of life as well as quantity of life.

But there is one side effect that can take a terrible toll on patients and their families and is especially concerning to drug plan sponsors: these medications are enormously costly, and put tremendous pressure on the sustainability of the drug benefit. Now available in Canada, Keytruda costs about $115,000 and Opdivo costs about $123,000 per year of treatment.

    Read: Financial burdens for Canadians with chronic and complex diseases are treatable

Since their initial Health Canada approvals, both drugs have received additional approvals for the treatment of other kinds of cancers, another trend that is putting upward pressure on plan spending.

A continued shift from intravenous drugs to drugs that are taken orally or self-injected is also undermining plan sustainability. In some provinces, government health plans cover therapies administered in a hospital, and while self-administered drugs are potentially much more convenient, this means that the exorbitant cost burden shifts to patients and their employer-sponsored benefit plan.

    Read: High-cost drugs put valuable employee benefit at risk.

Approximately 72% of all cancer drugs in development are designed to be self-administered outside of hospital settings. (DTR15 Page 69)

According to the latest Express Scripts Canada Drug Trend Report, 58% of all drugs approved in 2015 were considered specialty drugs (drugs used to treat chronic, complex conditions and that are usually costly) and one in three new specialty drugs approved is for the treatment of cancer. (DTR15 Page 43)

In other words, these new high costs drugs are already a primary driver of benefit plan spending increases, and this trend will intensify. To protect the sustainability of the highly valued drug benefit, it is essential that plan sponsors take action now to optimize benefits and patient health outcomes.

For more information on management solutions, see A strategic approach to safeguarding prescription drug benefits

Express Scripts Canada