Poor Patient Decisions Waste Up To $5.1 Billion Annually, According To Express Scripts Canada


MISSISSAUGA, Ontario, Canada, June 6, 2013 – Poor decisions by Canadian patients waste up to $5.1 billion annually on prescription drugs according to Express Scripts Canada (ESC), one of the largest providers of health benefits management services in Canada. This is one of the research findings of the 2012 Express Scripts Canada Drug Trend Report released today.

“Plan sponsors that provide health benefits to their employees have historically dealt with steadily rising costs for the prescription drug benefit,” said Michael Biskey, President of Express Scripts Canada. “Unfortunately, a huge portion of the money they spend on these benefits is wasted due to poor patient decisions. Reducing waste is the key to keeping prescription drug plans sustainable. By optimizing drug therapy and engaging employees to change their behaviours, plan sponsors can provide plan members effective health care at lower costs.”

Research from Express Scripts Canada’s report shows that poor patient decisions waste one out of every three dollars spent within a typical drug benefit plan. Express Scripts Canada defines waste as spending more without improving health outcomes. Sources of waste include channel waste and drug mix waste. Channel waste is driven by the use of higher-priced delivery channels as well as inferior dispensing intervals that result in more dispensing fees than necessary. Drug mix waste is created by using higher-priced prescription drugs when clinically equivalent alternatives exist. These components of waste mean that both plan sponsors and plan members pay more than necessary for their drug benefits.

In addition to channel and drug mix waste, plan sponsors experience costs related to “gaps in care” due to patient non-adherence to drug therapy. When plan members do not take medication as prescribed, it can lead to additional health-care issues, resulting in illness and disability related costs for plan sponsors and members. Express Scripts Canada’s research identified significant adherence related gaps in care in patients with diabetes, high blood pressure and cardiovascular disease.

“The good news is that plan sponsors and plan members can save money by implementing changes to how they manage their drug plans that will drive better decisions within the pharmacy benefit, and Express Scripts Canada has solutions to help,” continued Biskey.

Express Scripts Canada has found that reducing waste and closing gaps in health care can be achieved through the use of Active Pharmacy Benefit Management (PBM) best practices that engage, inform and influence patients and drive better plan member decisions. Express Scripts Canada’s Active PBM service integrates member, plan, cost and clinical information to trigger needs-based, proactive interactions that are specific, timely and relevant to each member. The programs are clinically based and rely on tools proven to change member behaviour in ways that will result in healthier outcomes and lower costs. Further, these programs have been designed to enable companies and organizations to work collaboratively with their employees to make the prescription drug benefit sustainable and more affordable.

Other key research highlights include:

  • The national average for annual prescription drug spend is flattening….for the time being. On a national basis, the average annual drug spend per claimant decreased 0.73% in 2012 to $755 per claimant, down $6 over the previous year. This modest decline is consistent with the flat trend of 0.5% recorded in 2011.The drug patent cliff and government pricing relief drove this reduction and masked a significant increase in specialty drug spend in 2012.
  • The trend for specialty drugs continues to climb, posting a trend of 13.3% in 2012. Specialty drugs include medications that treat complex conditions such as rheumatoid arthritis, multiple sclerosis and cancer. Use of specialty drugs increased 1.2% in 2012. By contrast, the cost per prescription grew 12.1% in 2012. The high cost per prescription and increase in utilization of specialty drugs were the major driving forces in the increasing private drug spend over the past couple years.
  • Specialty drugs are expected to drive future increases in drug spend. Express Scripts Canada has determined that 64% of items in the pipeline are specialty drugs. It is anticipated that specialty spend will grow to between 25-30% by 2017 up from 22% of total drug spend in 2012. This is dependent on the number of new specialty items that come to market.
  • Canadian plan sponsors that have implemented the Express Scripts Canada Active PBM Service have enjoyed significant savings. Participating employers have experienced plan savings of over 7% for the maintenance-medication of their prescription drug plan due to a reduction in channel waste and drug mix waste.

About Express Scripts Canada

Express Scripts Canada, a registered business name of both ESI Canada and Express Scripts Canada Services, each an Ontario partnership, is indirectly owned by Express Scripts, Inc., and is one of Canada’s leading providers of health benefits management services. From its corporate headquarters in Mississauga, Ontario, just outside Toronto, Express Scripts Canada provides a full range of active pharmacy benefit management (PBM) services to insurers, third-party administrators, plan sponsors and the public sector, including health-claims adjudication and processing services, Home Delivery Pharmacy Services, benefit-design consultation, drug-utilization review, formulary management, and medical and drug-data analysis services, to better facilitate the best possible health outcomes at the lowest possible cost. For more information about Express Scripts Canada, visit its Web site at www.express-scripts.ca.

About Express Scripts

Express Scripts manages more than a billion prescriptions each year for tens of millions of people. On behalf of our clients — employers, health plans, unions and government health programs — we make the use of prescription drugs safer and more affordable. We innovate to enhance patient care, reduce pharmacy-related waste and increase therapy adherence. Building on a strong clinical foundation, we apply our understanding of the behavioral sciences — an approach we call Consumerology® — to make it easier for people to choose better health. To learn more, go to http://lab.express-scripts.com.

Headquartered in St. Louis, Express Scripts provides integrated pharmacy benefit management services, including network-pharmacy claims processing, home delivery, specialty benefit management, benefit-design consultation, drug-utilization review, formulary management, and medical and drug data analysis services. The company also distributes a full range of biopharmaceutical products and provides extensive cost-management and patient-care services.

For more information, visit www.Express-Scripts.com

Express Scripts Safe Harbor Statement

This press release contains forward-looking statements, including, but not limited to, statements related to the Company’s plans, objectives, expectations (financial and otherwise) or intentions. Actual results may differ significantly from those projected or suggested in any forward-looking statements. Factors that may impact these forward-looking statements can be found in the Management’s Discussion and Analysis of Financial Condition and Results of Operations in the Company’s Form 10-Q filed with the U.S. Securities & Exchange Commission (SEC) on May 10, 2012. A copy of this form can be found at the Investor Relations section of Express Scripts’ Web site at http://www.express-scripts.com/corporate.

We do not undertake any obligation to release publicly any revisions to such forward-looking statements to reflect events or circumstances after the date hereof or to reflect the occurrence of unanticipated events.

SOURCE: Express Scripts Canada