Express Scripts Canada stays ahead of the curve to deliver better health benefits for less

05/04/2020

While prescription drug benefits continue to be threatened by the growing cost and use of high-cost specialty drugs, managing benefit investment through proven approaches that optimize drug costs along with member health is essential.

A leader in the pharmacy benefit management landscape, Express Scripts Canada recognizes this and leverages technology, innovation and data analysis to create better futures and health outcomes for members across Canada. Our expertise also helps our clients deliver affordable benefits programs to help manage costs.

The launch of the redesigned Express Scripts Canada 2020 Prescription Drug Trend Report, provides comprehensive research on the use of prescription medications in the Canadian private sector. This year’s Report confirms that innovative solutions are the key to controlling the cost of prescription drug benefit plans. Innovations that deliver potentially breakthrough treatments with high prices require equally innovative solutions in how the prescription drug benefit is managed. This is emphasized by the fact that costly, specialty drugs make up 60% of the total drugs in development.

The Report reveals that additional benefits have been found for drugs in therapy classes like diabetes and more costly options in diabetic supplies which can drive costs higher. While one in three Canadians are currently living with either diabetes or pre-diabetes, and an estimated one million are living with undiagnosed type 2 diabetes, this is a category to watch closely in the coming years. Especially since these numbers are increasing rapidly, with more than 480 people in Canada diagnosed with type 2 diabetes every single day.

Further, cancer treatment remains a primary pharmaceutical research focus. In addition, there are more than 30 new rare disease treatments on the drug pipeline horizon. Also, within the Top 10 therapeutic classes we saw that inflammatory conditions continues to represent the largest portion of overall spend and is ranked number one for the 19- to 35-year-old age group. The total impact of these developments will be considerable and is something to be mindful of as they will impact benefits costs in the coming years.

When it comes to keeping members healthy, those who manage multiple conditions and take multiple medications face unique challenges. These individuals have annual drug costs that are 16.2 times higher than the average member. They also struggle with taking their medications as prescribed, which is known as medication nonadherence. This is a million-dollar issue and can result in worsening health status, increased incidences of short-term leave, more hospital visits and avoidable health care expenses.

Nonadherence often affects the most prevalent chronic medical conditions, including high blood pressure, diabetes and depression. Since medications don’t work if they aren’t taken correctly, ensuring members are taking their medications as prescribed in the early stages of their condition can help prevent it from progressing.

For example, medication adherence for conditions such as high cholesterol and high blood pressure helps prevent long-term complications, such as heart attacks and strokes. This is significant as the data shows that 33% of members are nonadherent to these commonly prescribed medications. In fact, our data shows that 58% of plan members using two to three medications are nonadherent to at least one medication, and 77% of plan members using more than four medications.

Medication nonadherence is an area where innovative solutions are definitely required and Express Scripts Canada had made this serious health issue a priority. There are currently two solutions that address nonadherence.

The first is the Medication Nonadherence Identification Report, which identifies the most problematic medical conditions within the group and allows for targeted programs to benefit its members. The second is the Predictive Medication Adherence Report, which predicts who is at risk for nonadherence and identifies specific interventions to be implemented before the condition becomes detrimental to a member’s health. This proprietary predictive modelling focuses on the most prevalent conditions affecting our plan members: diabetes, high blood pressure and high cholesterol.

Another area of concern is the opioid crisis – a national emergency. Between January 2016 and June 2019, more than 14,000 Canadians died from opioid-related overdoses. In fact, in 2018 British Columbia reported a decrease in life expectancy, due in part to the opioid crisis.

A cause for concern is that many opioid users aren’t aware of the risks that come with taking opioids. For example, 1 in 5 Canadians suffer from moderate to severe chronic pain and might take opioids to help ease pain (for a back injury, for instance). But in these cases, the medication is intended for short term use only.

Express Scripts Canada is leading the way to safer opioid use through its Opioid Management Solution, which minimizes opioid exposure and prevents progression to misuse by limiting the “first fill” to a seven-day supply. This ensures a safe start of short-acting opioids. Early observations indicate, on average, an approximately 32% reduction in the average days’ supply per claim for first-time short-acting opioids, resulting in improved patient care and lower risks.

As we look ahead, we can see that benefit plan sustainability is threatened by rising costs, especially in areas such as diabetes and specialty medications. These costs can be lowered by introducing innovative solutions, such as medication adherence solutions, to help manage costs and improve member health.

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