What's happening in the Canadian prescription drug benefits marketplace?

The Express Scripts Canada 2016 Drug Trend Report shows prescription drug plans at a crossroads.

In 2016, our analyses in the 2016 Drug Trend Report revealed that:

• Spending on high-cost specialty drugs (those used to treat complex, chronic conditions such as severe rheumatoid arthritis, hepatitis C and cancer) has grown from 13% of total drug spending in 2007 to 30% in 2016.

• Tighter plan management and the successful completion of treatment for many hepatitis C Canadian patients moderated the specialty trend to 3.2% in 2016, a welcome respite after years of double-digit increases.

• Excluding hepatitis C medications, however, the specialty category trend was 10.7% in 2016.

• Trend on inflammatory conditions was 11.7% primarily due to an increase in utilization including expanding indications for high-cost, anti-inflammatory medications.

• One out of every five dollars spent on prescription drugs paid for medication for diabetes or an inflammatory condition

• The uptake of newer, more expensive diabetes drugs contributed to a trend of 13.7% in this category. But our analysis also shows that an alarming number of patients were not treated in accordance with the Canadian Diabetes Association’s Clinical Practice Guidelines, an example of an opportunity to potentially improve care while lowering costs with tighter plan management.

• There was also double-digit trend growth on cancer and attention-deficit hyperactivity disorder medications during 2016.

For more analyses on prescription drug trends, see our full 2016 Drug Trend Report.

What’s the solution?

The 2016 Drug Trend Report analysis shows that, while spending waste continues to be a troubling issue, a much more positive force is emerging.

Comprehensively managed prescription drug benefit plans are dialing back spending inflation and contributing to better health outcomes by delivering vital information and care to members. It’s a triple win: plan members experience better health, plan sustainability is protected and employers benefit from a healthier workforce.

Comprehensively managed plans focus on:

• Proactively engaging members at critical decision points;

• Aligning treatment with clinical guidelines;

• Helping members implement their decisions; and

• Providing comprehensive care to the growing number of members with multiple chronic conditions.

To do so, we leverage clinical expertise and data analytics and incorporate synergistic management techniques such as formulary, utilization and clinical management tools.

The result is the best possible patient care at the lowest possible cost.

In this rapidly changing environment, comprehensively managed plans have come at a critical point in the prescription drug benefits landscape as most Canadians simply do not have the clinical knowledge they need to determine which drug is the most cost-effective, clinically appropriate option for their treatment. The difference between the best decision and a suboptimal decision can be tens of thousands of dollars. Our research shows that optimizing spending on traditional maintenance drugs through pharmacy services that engage patients and influence better decisions can help fund access to new, high-cost drugs.

Since 2007, our annual drug trend reports have examined global prescription drug trends and leveraged clinician-informed analysis of the claims we manage for more than seven million Canadians each year.

Read: A strategic approach to safeguarding prescription drug benefits

Leading organizations are already realizing the rewards of proactive, strategic management. Their comprehensively managed drug plans are driving results that prove it is possible to help employee families effectively manage their health – while, at the same time, manage costs to protect plan sustainability.

Read: Financial burdens for Canadians with chronic and complex diseases are treatable

Are you worried about the sustainability of your prescription drug plan? Want to know how a comprehensively managed drug plan will help control plan costs? Contact us today!