Costs for specialized treatments rise almost 3 per cent
Overall, benefit drug spending increased by one per cent in 2019, reversing 2018 figures that showed a decrease, as costs for specialized treatments for such conditions as diabetes increased almost three per cent, according to Express Scripts Canada.
“Traditional spend for the first time did increase — albeit slightly, at 0.1 per cent — driven a lot by diabetic drug spend, so that’s something that we need to watch and consider,” says Dorian Lo, president of Express Scripts Canada in Mississauga Ont. “Specialty spend now accounts for one-third of overall spend and it continues to grow.”
Overall, people should be pleased that, on average, they were able to manage drug trends below inflation, he says.
“But we also know that the average experience doesn’t reflect a particular plan sponsor or employer’s experience so… it remains really important for people to have affordable health benefits.”
What was really driving the increased prescription drug costs was a dramatic increase (32 per cent) in specialty drug spending.
“In terms of things that people need to look for the future, it really is about the specialty spend, in terms of the pipeline that’s coming down, a lot of cancer drugs, a lot of expanded indications, rare diseases, in terms of new therapies in rare disease,” says Lo.
Traditional spending in diabetes treatment dropped in 2018, according to the study, but rebounded in a big way in 2019 (16 per cent). Inflammatory conditions were ranked as the highest drug cost by spend (13 per cent), followed by diabetes (nine per cent) and asthma/COPD (5.3 per cent), found the report.
Biosimilars come into play
Some good news is on the horizon for benefits providers, according to Lo, as the rise of biosimilar drugs will have a big effect in the market in 2020.
“Just like generics starting out many years ago, biosimilars are really now being launched and they come at a lower price — not as low as generics — but doctors, if they were to prescribe the so-called biosimilars… there’s significant cost savings. We’re going to see that a lot more in the upcoming years and there’s additional biosimilars that are expected to be launched next year that will provide additional savings.”
HR departments should be searching for new ways to save on benefit spending, he says.
“[It’s about] looking for opportunities, like biosimilars, working with your carrier or PBM (pharmacy benefit manager) just to see what their biosimilar strategy is and how they’re going to maximize the savings and the care that patients are getting through their specialty program overall, that they can also take advantage of.”
Non-adherence still a challenge
But one of the main areas of concern is patients who don’t take prescribed medications, which drives up costs to the benefits provider. As many as 70 per cent of Canadians did not take their prescribed medications in 2019, with about 26 per cent of prescriptions not being filled, found the study.
More than one-third (38 per cent) of employees with depression are non-adherent, meaning they don’t take all of their medication, while another 33 per cent of workers on high blood-pressure medications are non-adherent.
“We need to remember that the pharmacy drug benefit is a benefit — it only works when people take their medication,” says Lo.
