Rising Drug Spend – With Almost One-Third Focused on Three Diseases – Calls for Innovative Solutions

The last two years saw monumental shifts in virtually every aspect of our personal lives, work, and businesses.

Within pharmacy benefit management, these changes are mostly amplified continuations of trends that started long before COVID-19 swept the globe.

While these trends are driven by various factors that affect healthcare costs in Canada – such as demographic changes, pharmaceutical advances, economics, and politics – they all point to one clear conclusion: drug spend is on the rise.

The latest ‘Prescription Drug Trend Report’ released this year by Express Scripts Canada revealed that total private drug spend per member rose to $553 in 2021 from $485 in 2019 – a 10 per cent increase. Yet the percentage of members who submitted claims last year actually went down by 0.3 per cent. What this tells us is that the comparatively smaller number of claimants are, on average, spending more individually – 4.9 per cent more, to be precise.

For benefit managers, plan sponsors and members, these numbers underline a need to find solutions that strike a balance between giving Canadians ongoing access to the medications they need and ensuring their drug plans are sustainable in the long term.

A closer look at the data provides context – and a pathway to the most effective solutions.

Top Three Therapeutic Classes

In addition to providing aggregate numbers, the report presents a picture of the health conditions most worrisome for Canadians. According to the data, Canadians are most in need of prescription drugs in three therapeutic classes that account for almost one-third of total private drug spend: inflammatory conditions, diabetes, and depression.

Drugs for inflammatory conditions have claimed the top spot for many years, accounting for 13.3 per cent of private drug spend. The drug ustekinumab, sold under the brand Stelara and indicated for Crohn’s disease, ulcerative colitis, plaque psoriasis, and psoriatic arthritis, saw a 14 per cent increase in claimants and 16.2 per cent increase in spend. But this drug’s popularity was surpassed in 2021 by risankizumab – marketed in Canada as Skyrizi – which increased by 59 per cent in drug spend, possibly because it delivered better clinical results than Stelara for moderate to severe plaque psoriasis.

Diabetes medications – at 10.6 per cent of total spend in 2021 – have consistently ranked second in private drug spend in Canada. The report attributes this continued high ranking to a 9.4 per cent rise in the number of claimants, which may be due to a growth in new diagnoses of Type 2 diabetes, updated guidelines that recommend additional therapies as the condition progresses, and more patients finally seeking healthcare after staying away from the doctor in the first year of the pandemic.

A notable trend in spend on diabetes medications in 2021 was a 70 per cent increase in claimants for semaglutide, a drug for Type 2 diabetes. At a per-claim- ant cost of $1,400 per year, semaglutide accounted for 24 per cent of diabetes spend in 2021, up from just 16 per cent in the previous year.

What will come as no surprise to anyone who has observed – and perhaps experienced – the collective anxiety brought on by the pandemic is the continued rise of spending on medications for depression. In 2020, this class of therapeutics was ranked fourth by share of total drug spend. By last year, it was in the Number Three spot.

We can expect even more claims for depression medication in the near future. We know from the report that an estimated 50,000 Canadians have yet to start drug treatment for depression.

Cancer Backlog

We also anticipate increases in drug spend for other therapeutic classes, including cancer, which now has a backlog of approximately 10,000 Canadians after a 5.4 per cent increase in claimants in 2021. The trend towards more sophisticated treatments such as gene therapies and bio- logics will likely continue to build. These game-changing medical approaches have tremendous potential to effectively treat disease, but their significantly higher price tags could threaten the sustainability of private, as well as public, drug plans. These   numbers   from   the   Express Scripts Canada report drive home this point: specialty drugs represent less than one per cent of all claimants, but account for almost 30 per cent of total drug spend. Many of the trends reported in this report are unlikely to move in reverse anytime soon. Our population is aging, with seniors expected to make up almost a quarter of all Canadians by 2030. Almost 27 per cent of us live with obesity, a leading cause of serious health problems that include Type 2 diabetes, high blood pressure, heart disease, stroke, arthritis, and cancer.

Sustainable Drug Plan Strategies

We hear this all the time at Express Scripts Canada Pharmacy, which offers online prescription refills, right-to-your- door delivery, and 24/7 access to qualified pharmacists through our mobile app or a web browser. Last year, it saw double-digit growth – proof of Canadians’ appetite for convenient online access to pharmacy services.

The COVID-fuelled acceleration of healthcare technology has made it easier than ever to deliver innovative solutions for sustainable drug plans. For our teams, where leading edge research and data analytics have driven evidence-based innovations for years, there has never been a more exciting time.

As we continue to move past the pandemic, we know there’s an urgent need for more innovative solutions in pharmacy benefit management. We’re up to the challenge and we hope plan sponsors and members are too.

Christine Griffin is General Manager, Private Payor Solutions at Express Scripts Canada.