The 2021 Express Scripts Canada Prescription Drug Trend Report: Key takeaways reveal innovative solutions that leverage actionable data are essential to plan sustainability

04/05/2021

ESC’s data reveals spike in trend, specialty medications in pipeline and pent up disease pose potential threats to plan sustainability

By Jeff Boutilier
General Manager, Pharmacy & Chief Clinical Officer

Express Scripts Canada’s 2021 Prescription Drug Trend Report is the industry’s most comprehensive and influential examination of year-over-year changes in the cost and use of prescription medications made by Canadians.

Divided into three sections – Drug Trend & Utilization, Pharmacy Landscape and Innovation – this year’s report confirms that the healthcare landscape is evolving with pharmacological interventions at a rapid rate; whole-person health is fundamental to wellbeing and care access is rapidly changing. Comprehensively managed plans are key to maintain benefit plan sustainability and achieve the best possible health outcomes for plan members.

Here are the key takeaways from this comprehensive breakdown on the use of prescription medications in the Canadian private sector:

Overall trend saw a 5.4% spike in 2020, as COVID-19 caused an increase in claims due to drug shortages, provincial restrictions and stockpiling. The timing of COVID-19 vaccinations, implementation and lifting of lockdown restrictions, and whether the healthcare system returns to pre-pandemic capacity levels are among factors expected to continue influencing trend through 2021.

Specialty drugs continue to make up 60% of the development pipeline, with drugs to treat rare disease and cancer the largest contributors. Last year, the overall specialty spend in the more-than $100,000 annual cost category was up 23.3% from 2019. The extremely high prices of these breakthrough treatments mean that plan design must be equally innovative to protect plan sustainability.
Potentially, more than 100,000 Canadians living with undiagnosed chronic diseases did not commence treatment in 2020 for chronic diseases, and could seek a diagnosis and treatment in 2021 or beyond. This alarming trend is reflected in 2020’s significant drop in new claimants for chronic diseases like diabetes, cancer and depression. For these and other conditions, seeking care in the earlier stages likely improves health outcomes and helps decrease the risk of disease progression and related consequences.

The increased approval of biosimilars in Canada is a sign of this category’s continuing momentum.Several biosimilars are currently under review by Health Canada. If approved, these medications could further drive savings opportunities for private payers.
ESC’s innovative solutions, which leverage actionable data to predict modelling behaviour, are essential to support the development and implementation of personalized strategies to target members struggling with chronic or complex conditions.

Express Scripts Canada leverages the valuable insights derived from our annual report to work with our clients to drive affordability and sustainability for prescription drug plans.

Historically, plans have deployed cost-saving strategies to provide member access to the most cost-effective medications to manage prescription drug spend, such as managed formularies and utilization management. However, these tools have not been as rigorously applied to specialty medications. For example, biosimilar transitioning is complex and has come up against several barriers. Additionally, with the rise in costly gene therapies, it is clear that a comprehensive approach to plan sustainability is required.

Plans should leverage a full menu of comprehensively managed plan tools, including:

Formulary management that provides access to clinically effective medications while targeting high-cost therapies that offer no added clinical benefit,
Utilization management, where tools such as prior authorization and step therapy programs guide patients to safer, more cost-effective drug choices and to ensure the right drug is provided to the right patient, by the right payor, at the right time,
Channel management that leverages a network of preferred pharmacies, such as home delivery, to drive down costs while delivering improved patient care, and
Patient health management that delivers specialized holistic care to help patients better manage treatment complexity, resulting in lower costs and healthier outcomes.

When combined, these tools can improve care, bend the curve on spending and maintain plan sustainability.

As we look ahead, Express Scripts Canada will continue to partner with our clients as we work to build a better prescription drug benefit future – together.

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