Canadian Employers Will Face a $5.6 Billion Price Tag for Specialty Drugs Within the Next Five Years


Innovative benefit management solutions required to maximize drug spending ROI

MISSISSAUGA, ON, May 10, 2016 – Express Scripts Canada, one of the country’s leading providers of health benefits management services, today announced the results of its annual Drug Trend Report.

According to the report, which draws on analysis of prescription drug claims from millions of Canadians, high-cost specialty medications threaten the ability of employers to continue to offer a comprehensive prescription drug benefit to their employees.

Spending by Canadian employers on specialty drugs — those used to treat chronic, complex conditions such as cancer and hepatitis C — is expected to nearly double to $5.6 billion for private plans by 2020. Adding to concerns about newly approved treatments costing hundreds of thousands of dollars per patient are the 7,000 drugs currently in the development pipeline, most of which are specialty medications. At the same time, the number of patients requiring these treatments is rapidly increasing.

“From an economic and employee satisfaction perspective, the pharmacy benefit is highly valued by employers,” says Michael Biskey, President of Express Scripts Canada. “It provides access to treatments on which many Canadians rely. However, unless plan sponsors take action now, it will quickly become unaffordable, making it necessary to transfer the burden of cost and financial risk to employees. If that happens, there is likely to be severe consequences for the health and financial wellbeing of Canadians.”

Biskey stresses that Express Scripts Canada has applied clinical expertise, behavioural science and experience with millions of private plan members – as well as advanced data analytics – to develop solutions proven to balance costs and encourage healthier outcomes for employees. “Our active plan management and pharmacy solutions support employees and their families in achieving better health and reducing out-of-pocket costs while minimizing plan spending and contributing to better drug benefit ROI for employers. More optimized solutions and more educated choices mean less waste, which in turn means more funding for higher-cost specialty drugs when those potentially life-saving treatments are required by employees and their dependents.”

Additional key findings from the study include:

  • High-cost specialty medications continue to consume an ever-larger portion of total prescription drug spending, increasing to 29.9% in 2015 from an already alarming 26.5% the year before. Of greatest concern to plan sponsors is that specialty spending is on track to reach 42% of total spending by 2020, threatening plan sustainability.

  • Intravenous and injectable treatments administered in hospital settings are rapidly being replaced by new medicines that can be self-administered by the patient. This shifts the cost burden from public plans, which pay for drugs administered in a hospital, to private plans and patients. About 47% of all cancer drugs in development (a total of more than 1,800) are oral medications; another 25% are non-oral self-administered medications.

  • Uninformed patient decisions result in up to $1 out of every $3 spent on drug benefits not contributing to better health. Without the right kind of support at the right time, Canadians choose more expensive medications even when lower-cost alternatives provide similar benefits. Too many aren’t able to follow their doctors’ instructions, resulting in worsening health and enormous financial tolls on benefit providers.

About Express Scripts Canada

From its corporate headquarters just outside Toronto, Express Scripts Canada transforms the way organizations and employees think about and participate in their drug benefit plan. Express Scripts Canada provides 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
Manager, Marketing & Communications
Express Scripts Canada
905-712-8615, ext. 642256
LinkedIn: Express Scripts Canada
Twitter: @ExpressRxCanada