The impact of COVID-19 on prescription drug trends: breaking down the data

Over these past seven months, COVID-19 has upended our daily lives in a very short period of time, leaving a monumental mark on the world’s health and economy. It’s changed the way we work, how we access healthcare services and the way we connect with each other. It has introduced safety precautions that haven’t been implemented in over a century, like social distancing, proper hygiene and wearing a mask in public. Our collective struggle with uncertainty continues, which has taken its toll on our mental and emotional wellbeing.

In addition to the use of prescription medications, the pharmacy benefits management field itself has been impacted by the pandemic. Areas such as claim volume, claim value and key therapeutic areas, have taken a hit like no other year we’ve seen in our collective memory, with the potential for daunting – and lasting – impacts for the remainder of the year.

Read more: Health care trends provide insight into Covid-19’s impact on Canadians

A phased approach to data

As the leader in pharmacy benefits management, Express Scripts Canada remains committed to focusing on innovation and using data to focus on what matters most to those we serve: better health benefits for less. When it comes to drug claims data as related to COVID-19, the data has been broken down into four key phases:

1. Pre-COVID: This is from the beginning of 2020 to early March.
2. The transition period: The approximate time before self-isolation.
3. Self-isolation: This is the timeframe when schools, day cares and workplaces were closed in order to encourage social distancing.
4. Re-Opening: The phase when orders are relaxed and medication supply has stabilized.

These time frames are approximate as provinces implemented measures at different times. However, it gives us a basis for analysis.

Watch: How do I stay safe as COVID-19 restrictions are lifted?

What to watch for: trends
Overall Trend Update – Claim Volume

Claim volumes (or the number of claims) were up 14% compared to 2019 during the transition phase. This is most likely because of stockpiling that began in advance of the anticipated self-isolation period. During self-isolation, claims dropped by 6% compared to 2019. Claim volumes increased 5% during the re-opening phase.

Overall Trend Update – Claim Value

Compared to 2019 data, claim values were up 16% during the transition period and fell to negative 14% during the self-isolation period. This was driven by the 30-days’ supply limits imposed by provinces (what would have once been a 90-day claim, under these restrictions would have been three separate 30-day claims). While these limits were lifted in May and June, the spike seen due to the COVID-19 pandemic and resulting self-isolation will have an impact on trend for the remainder of 2020.

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

Overall Trend Update – Key Therapeutic Areas

The drug classes impacted by COVID-19 were: respiratory (medications given to act directly on the lungs), mental health (medications used to treat mental health problems) and anti-infectives (medications used to inhibit or stop the spread of infection). Medications used for asthma/COPD had highest claim value and volume increase of all therapeutic categories during pre-self-isolation period. Medications, like salbutamol, used to treat asthma/COPD, saw supplies allocated to hospitals and, therefore, forced manufacturers to deliver minimum quantities to pharmacies. The announcement of salbutamol shortages could have led to stockpiling.

Based on our data, new claimants for antidepressants could be from members with a new diagnosis of depression or anxiety. When it comes to a comparison of 2020 data to 2019 data, we saw a 20% increase in claimants for medications related to depression. A contributing factor to this increase could be related to a new diagnosis of anxiety or depression. At the end of August, we were at 97% of the 2019 total claims volume for this medication class.

Read more: COVID-19 and mental health: A growing threat to Canadians

The last therapeutic category impacted was anti-infectives, which experienced a steep decline in claims during the self-isolation period. This decline is due to sites of common transmission (i.e. workplaces, schools, daycares and gyms) being closed, an increased consciousness about and the practice of hygiene practices (such as hand washing, sanitizing, not touching the face, etc.) and hospitals and doctor’s offices closed to non-urgent cases. This therapeutic class was ranked #11 in 2019, but could fall further this year. With self-isolation restrictions easing nationwide and an increase in options for accessing urgent healthcare remotely we will carefully monitor what this last quarter of 2020 has in store.

Where do we go from here?

So how will the remainder of 2020 impact plan members and claims? As of August 31, ESC data shows a total claim volume of 91% as compared to 2019. This is good news, as it moves us closer to the stabilization of claim volume after the initial stockpiling phase. However, the 30-days’ supply restrictions will have a lasting impact on cost per claimant. We could also see some movement in our top therapeutic classes; with anti-infectives dropping. We also know that the pandemic has taken a toll on Canadians emotionally. With a 20% increase in claimants, mental health will require a holistic approach to employee well-being. Finally, as many provinces have expanded the pharmacist’s scope of practice to increase first-line response to the pandemic, this will build a case for future activities.

If a predicted second wave hits, we could see similar scenarios in terms of claims. If there is no second wave, there will most likely be a stabilization in claims for the remainder of the year.