2021 Prescription Drug Trend Report signals that significant numbers of Canadians are potentially living with undiagnosed chronic diseases

Data from the 2021 edition of Express Scripts Canada's annual Prescription Drug Trend Report suggests that the number of Canadians with untreated chronic diseases has significantly increased in the wake of the COVID-19 pandemic.

Analysis of the data led to this conclusion: Potentially, more than 100,000 Canadians living with undiagnosed chronic diseases did not begin treatment in 2020. The report states that this alarming trend is reflected in 2020's significant drop in new claimants for drugs used to treat chronic diseases like diabetes and cancer.

"This trend is a cause for concern," says Dr. Dorian Lo, President, Express Scripts Canada. "Delays in diagnosis and treatment increase the challenge for patients to manage their disease. For most conditions, seeking care in the earlier stages likely improves health outcomes and helps decrease the risk of disease progression and related consequences."

"The fluctuations in stay-at-home orders, the focus on critical healthcare resources (i.e., medical emergencies) and general population fears all have an impact on the health of Canadians," adds Dr. Lo.

As Canada's foremost pharmacy benefits manager, Express Scripts Canada's annual Prescription Drug Trend Report offers in-depth drug-trend insights based on comprehensive data analysis of aggregate prescription claims in the Canadian private sector (private health benefits plans).

Delayed treatment in major therapeutic areas

The number of weekly new claimants in 2020 was lower than expected in several major therapeutic areas.

Individuals who became sick or developed new symptoms last year may have delayed a visit to a health professional due to accessibility issues (closed or reduced services) or fear of exposure to the coronavirus. 

"Those people who didn't seek medical attention for potential chronic diseases in 2020 could seek a diagnosis in 2021 or beyond," says Jeff Boutilier, General Manager, Pharmacy & Chief Clinical Officer, Express Scripts Canada. "Benefits plans could be affected by greater numbers of claimants in the future. A growing backlog of new claimants in major therapeutic areas is expected to have long-term repercussions for benefits plans and disease management."


  • Cause: From the end of March to December 2020 there was an average 2 per cent decline of weekly new claimants for cancer medications.
  • Possible Impact: An estimated backlog of more than 10,000 Canadians who potentially have not started treatment for cancer.

"Delays in cancer screening and the interruptions to surgeries may result in a shift towards treating more advanced cancers, with fewer therapeutic options at a higher cost," says Mr. Boutilier.


  • Cause: From the end of March to December 2020 there was an average 1 per cent decline in weekly new claimants for diabetes medications.
  • Possible Impact: An estimated backlog of more than 20,000 Canadians who potentially have not started treatment for diabetes.

"Delayed treatment of diabetes is associated with a higher risk for therapy intensification," continued Mr. Boutilier.


Cumulative backlog of claimants with delayed treatment of conditions draws concerns related to possible consequences of increased health-related issues like the risk of a heart attack or stroke.

Possible impact: More claims for medications required to treat this condition and the potential need for combination therapies

About Express Scripts Canada
Express Scripts Canada is a leading health benefits manager in Canada and has been recognized as one of the most innovative. Our clients include Canada's leading insurers, third party administrators and government. We work with these clients to develop industry-leading solutions to deliver superior healthcare in a cost-controlled environment. We provide Active Pharmacy™ services to more than 7 million Canadian patients and adjudicate more than 100 million pharmacy, dental, and extended health claims. Through our proprietary consumer intelligence, clinical expertise, and patients-first approach, we promote better health decision for plan members, while managing and reducing drug benefit costs for plan sponsors. Express Scripts Canada is a subsidiary of Express Scripts, a Cigna® company.

For further information: Nancy Tibbo, Sr. Manager, Marketing & Communications, Express Scripts Canada, 416 918-7137 or ntibbo@express-scripts.com.