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Employers face $5.6-B drug plan price tag, here’s how big data can trim down the cost

Between now and the year 2020, the amount that Canadian employers pay for their workers’ specialty drugs under various company prescription plans is expected to double to $5.6 billion. That’s the forecast of Toronto-based healthcare benefits management firm Express Scripts Canada which annually tracks the cost of maintaining employer-funded private healthcare plans.

The company also estimates that employer-funded insurance plans in the country wasted more than $3 billion a year between 2011 and 2015 by covering prescriptions for expensive medicines and paying unnecessary dispensing fees even when there were cheaper options available.

The amount of waste is staggering, according to John Herbert, a research expert for Express Scripts Canada. John Herbert

“One of the key drivers of the increasing cost is the use of specialty drugs. These are high-cost medication — those used to treat chronic, complex conditions such as cancer and hepatitis C,” he said. “We can trace the problem to lack of information. Money being spent on expensive drugs when there are cheaper but also effective alternatives.”

However, employers can dramatically cut their healthcare plan expenses by using the power of data analytics to help employees and their physicians easily identify alternative prescription drugs and pharmacies that charge lower dispensing fees.

High-cost specialty medications continue to consume an ever-larger portion of total prescription drug spending, increasing to 29.9 per cent in 2015 from an already alarming 26.5 per cent the year before, according to Express Scripts’ numbers.

“Of greatest concern to plan sponsors is that specialty spending is on track to reach 42 per cent of total spending by 2020, threatening plan sustainability,” a report by the company said.

And this is bad news for employees, said Herbert.

That’s because, the typical response of many employers is to introduce annual minimums on prescription coverage which has the effect of limiting if not barring patient access to medication that can be “life changing,” he said.

Express Scripts Canada