Express Scripts Canada Prescription Drug Trend Report: Active management critical

MISSISSAUGA, ON, May 9, 2018 – With concern rising over the long-term affordability of prescription drug plans, employers and other drug plan sponsors should be looking to comprehensively managed prescription drug plans as a solution that promotes better health outcomes at a lower cost. This was the primary finding of the Express Scripts Canada Prescription Drug Trend Report: Trends in Canadian Private Benefit Plans, released today.

“Year after year, we see increases in the amount spent by prescription drug plans,” said Express Scripts Canada president Michael Biskey. “And the majority of these costs are concentrated on a relatively small number of claimants. Clearly, there is an opportunity for better health and financial outcomes if we actively engage and guide this group, and we can do that through comprehensively managed plans.”

Overall, private plan spending on prescription drugs increased by 2.5% from 2016 to 2017, driven once again by increased spending on specialty drugs, which now accounts for 31% of the total spend, up from 15% in 2008. This trend shows no signs of slowing down, with specialty drugs representing a majority of new drugs in the development and approval stages.

Improving health outcomes and financial outcomes through targeted support

By drilling down the distribution of claimants, it becomes clear that providing targeted support to members with high-cost chronic conditions is the key to controlling costs. These members – just 20% of claimants – drive almost 80% of plan costs with average annual drug spending that is 15 times that of other claimants. Members in this group have, on average, 7.8 chronic conditions, see 3.3 physicians and take 8.9 medications – understandably, they struggle with the complexity of their treatments. An average of 49.5% of these members are non-adherent to one or more of their medications. These gaps in adherence can possibly lead to worse health outcomes, and ultimately even greater costs for the drug plan.

Given high levels of coexisting conditions, a holistic approach is required to drive lower costs and healthier outcomes. By understanding the needs of these members and providing them with timely support, it is possible to have a powerful impact on the majority of costs while supporting better health outcomes at the same time.

Providing targeted, timely support to help these members make decisions that optimize cost and care is essential. Comprehensively managed plans provide support to these most needy patients by helping them improve medication adherence, optimizing treatment to reduce costs and, in some cases even helping them secure funding to help the patient reduce their drug costs.

Other key findings:

  • High-cost specialty medications, which make up 2% of total claims but account for over 31% of total drug spend, increased by 6.5% in 2017.
  • The top 10 therapy classes by spending accounted for 58.6% of overall spending.The use of high-cost specialty medications to treat common chronic conditions such as Asthma, COPD and High Cholesterol is increasing.
  • Generic drugs accounted for 63.1% of all claims and 22.5% of specialty claims (up from 62.3% and 22% in 2016) due to a combination of patent expirations and generic substitution plan controls.
  • Together, medication for inflammatory conditions and diabetes accounted for 24% of overall spending.
  • Cancer spending increased by 10.8% and ranked #7 by overall spend in 2017, up from #10 in 2016.

The near-term drug development pipeline includes over 145 new medications, which includes gene-based therapies and other high-cost medications, which could increase costs and threaten benefit plan sustainability. In addition, expanding treatment indications for existing high-cost drugs will put further cost pressure on drug plans.

About Express Scripts Canada

From its corporate headquarters just outside Toronto, Express Scripts Canada transforms drug benefit plans for employees and employers through unique and highly innovative solutions. Express Scripts Canada provides innovative pharmacy services to thousands of Canadian patients. Through its proprietary consumer intelligence, clinical expertise, and patients-first approach, Express Scripts Canada promotes better health decisions for plan members, while managing and reducing drug benefit costs for plan sponsors. Express Scripts Canada is indirectly owned by Express Scripts Holding Company.

For further information:
Nancy Tibbo
Senior Manager, Marketing & Communications Express Scripts Canada
416 918-7137