Specialty Drug Spend Unsustainable According to Express Scripts Canada's Drug Trend Report


Employers May Become Unable to Afford Comprehensive Employee Drug Benefits

MISSISSAUGA, ON, May 28, 2014 /CNW/ - Spending on specialty drugs - those used to treat serious, complex conditions such as multiple sclerosis, cancer and rheumatoid arthritis - is likely to increase at a significant rate, substantially impacting the cost employers pay to include them in their healthcare benefit plans for employees, according to the Express Scripts Canada 2013 Drug Trend Report released today.

Overall, specialty drugs are used by a small population of patients in Canada, but their total cost is becoming increasingly significant. In 2013, specialty drugs made up less than 1.3 percent of all Canadian prescriptions, but accounted for 24 percent of Canada's total spending on prescription drugs. The average annual drug treatment cost for each patient with cancer drug claims is $10,690, which is approximately 14 times the national average of $765 per patient in Canada. This reality will require employers to increase the funding for drug benefits or modify the way drug plans are structured for their employees.

"New specialty drug treatments are making a real difference in the lives of patients, but the high cost of some of these drugs creates difficult decisions for employers who have to decide which medications to cover," says Michael G. Biskey, President, Express Scripts Canada. "Our research tells us that a large portion of the money employers spend on overall drug benefits (specialty and non-specialty drugs) is wasted due to poor patient decisions. The good news is that Express Scripts Canada has solutions to help employers manage the costs associated with the prescription drug benefit, enabling employers to sustain coverage of specialty medications. Now is the time for employers to act so they can continue to offer a comprehensive pharmacy benefit for their employees."

Additional key findings from the study include the following:

  • Specialty spend represents only 1.3% of claims but continues to grow as a percentage of total drug spending, steadily increasing from 13.2% in 2007 to 24.2% in 2013. This increase is primarily driven by high treatment costs and an increase in utilization.
  • Spending on traditional prescription drugs - those used to treat common conditions such as high blood pressure - declined by 1.2 %. This downward trend is driven almost entirely by the availability of generic drugs coupled with reduced generic prices imposed by provincial drug reform.
  • Drug benefit costs are expected to increase in the future primarily driven by the continued growth in utilization of specialty drugs.
  • Up to $1 ;of every $3 spent on drug benefits is wasted due to poor patient decisions. Patients continue to use more expensive medications when less expensive alternatives will provide similar health benefits. Patients also use expensive distribution channels, use less than optimal dispensing intervals and often fail to take prescription medication as prescribed. This results in significant health consequences for patients and enormous financial tolls on benefits providers.
  • Traditional prescription drug benefit management tools are limited in their ability to drive better patient decisions, which has resulted in unnecessarily high costs and a cost shift from employer to employees. New strategies that leverage behavioural science are proven to influence patients to make better decisions which lower costs and can improve health outcomes.

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 more information visit www.express-scripts.ca.