Prescription drug plan sustainability at risk: Comprehensively managed plans the best answer to reduce costs, improve health outcomes and ensure plan sustainability


MISSISSAUGA, ON, May 3, 2017 – The cost of specialty prescription drugs to treat conditions like cancer and hepatitis has doubled over the past decade, and with more high-priced drugs in development, private-sector employers need to act now to preserve benefits for their members, according to the Express Scripts Canada Drug Trend Report released today.

The report, which draws on analyses of prescription drug claims from millions of Canadians, shows that private plan spending increased again in 2016 and that rising drug costs, particularly related to high-cost drugs and high-cost patients, undermine the ability of employers to continue to offer a prescription drug benefit to their employees.

"More and more employers are limiting employee access to treatment coverage in an attempt to protect drug plan sustainability because they don’t understand they have other, better options available to them," says Michael Biskey, President of Express Scripts Canada. "Employers can greatly improve their overall spending and the sustainability of the prescription drug benefit through the introduction of a comprehensively managed prescription drug plan and this is where Express Scripts Canada can help."

Biskey stresses that the number of working-age individuals with multiple chronic conditions who require numerous treatments is on the rise. Such patients are usually prescribed a number of treatments by many doctors and specialists, often without the benefit of coordination of care or an understanding of their drug benefit. These people need expert guidance at key decision points along their healthcare path. "Most Canadians simply do not have the clinical knowledge they need to figure out which drug is the most cost-effective, clinically appropriate option for their treatment."

"Employers need to act today to introduce comprehensive managed plans, before cost increases become insurmountable. Our 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. Focusing plan management efforts on empowering members to make more effective, informed decisions can help fund access to higher-cost specialty drugs when those potentially life-saving treatments are required by employees and their dependents."

Additional key findings from the study include:

  • Spending on high-cost drugs (those used to treat complex, chronic conditions such as hepatitis C and cancer) has grown from 13% of total drug spending in 2007 to 30% in 2016.
  • 14% of plan members account for 72% of total plan spending.
  • One out of every five dollars spent on prescription drugs in 2016 paid for medication for diabetes or an inflammatory condition.
  • There was double-digit growth in spending on cancer and attention deficit hyperactivity disorder medications during 2016.
  • Cancer treatments dominate the drug development pipeline and a continued shift from hospital-administered drugs (covered by public plans) to self-administered drugs is expected to mean more private-sector claims and higher costs in the future.

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