Avoiding Poor Health Choices – Creating Better Health Outcomes


From a cost perspective, private employer drug plans are under siege. New treatments have been introduced in the Canadian market at alarming prices, such as a staggering $71,000 for a new treatment for hepatitis C. At the same time, high-cost claimants – those whose prescription costs ranged from $6,900 to $755,000 in 2014 – are taking an increasingly large slice of the benefit pie: the top 1% of all claimants comprised 28% of total spending in 2014.

Many companies are taking measures to limit prescription drug spending to keep the benefit plan sustainable. But the effect can be to simply shift the cost to employees, ultimately undermining a company’s ability to attract and retain top talent. It can also undermine health outcomes, as high costs can contribute to non-adherence – patients who don’t follow their doctors’ advice, potentially leading to worsening of symptoms, lost productivity and disability.

Informed, effective patient decisions have an essential role to play in keeping drug plans sustainability.

Express Scripts Canada research reveals that, each year, billions of dollars of prescription drug spending is wasted in Canada. In fact, $1 in every $3 spent does not improve patient health outcomes. These decisions are simple and understandable – for example, patients use brand-name medications when generic options are available and proven to be of equivalent effectiveness, and they incur much higher pharmacy fees than necessary.  

More effective choices can provide healthier outcomes and save billions of dollars. Patients want the same outcomes as employers – better health at sustainable costs – but they need help making the right decisions.

The solution is active benefit management, an approach based on behavioural science that is designed to provide the right support at the right time. For instance, if a physician has prescribed an expensive brand medication when a lower cost alternative is available, one of Express Scripts Canada’s pharmacists will reach out to the physician. This type of proactive, timely support translates into substantial savings for patients and employers, with the potential to improve adherence as well as plan sustainability.

This level of pharmacy support can also help improve patient non-adherence caused by other reasons, such as forgetting to refill a prescription on time. In 2014, Express Scripts Canada research found that getting prescriptions from more than one pharmacy had an impact on adherence: 54% of patients who obtained their medications from just one or two pharmacies were adherent. When patients obtained their drugs from five or more pharmacies during the year, only 37% were adherent.

Pharmacy solutions that provide comprehensive counselling and services, side effect management, specialized pharmacists and coordination of care can also help patients manage multiple complex conditions, translating into better health outcomes. 

With strategic pharmacy services support, Canadian patients can drive billions of dollars of waste from private drug plan spending, improving their health outcomes as well as helping to ensure the sustainability of employer benefits.