Private plan spending on prescription drugs up 2.5 per cent in 2017

Specialty drugs now account for 31 per cent of total spend: Report
|hrreporter.com|Last Updated: 05/10/2018
Benefits, employee benefits, payroll, health care
High-cost specialty medications, which make up two per cent of total claims but account for over 31 per cent of total drug spend, increased by 6.5 per cent in 2017. REUTERS/Chris Wattie

Overall, private plan spending on prescription drugs increased by 2.5 per cent from 2016 to 2017, driven by increased spending on specialty drugs, which now accounts for 31 per cent of the total spend, up from 15 per cent in 2008.

And members with high-cost chronic conditions – 20 per cent of claimants – drive almost 80 per cent of plan costs, with an average annual drug spending that is 15 times that of other claimants, according to the Express Scripts Canada Prescription Drug Trend Report: Trends in Canadian Private Benefit Plans.

Members in this group have, on average, 7.8 chronic conditions, see 3.3 physicians and take 8.9 medications.  An average of 49.5 per cent of these members are non-adherent to one or more of their medications.

“Year after year, we see increases in the amount spent by prescription drug plans,” said Express Scripts Canada president Mike Biskey. “And the majority of these costs are concentrated on a relatively small number of claimants. Clearly, there is an opportunity for better health and financial outcomes if we actively engage and guide this group, and we can do that through comprehensively managed plans.”

Other key findings:

  • High-cost specialty medications, which make up two per cent of total claims but account for over 31 per cent of total drug spend, increased by 6.5 per cent in 2017.
  • The top 10 therapy classes by spending accounted for 58.6 per cent of overall spending.The use of high-cost specialty medications to treat common chronic conditions such as asthma, chronic obstructive pulmonary disease (COPD) and high cholesterol is increasing.
  • Generic drugs accounted for 63.1 per cent of all claims and 22.5 per cent of specialty claims (up from 62.3 per cent and 22 per cent in 2016) due to a combination of patent expirations and generic substitution plan controls.
  • Together, medication for inflammatory conditions and diabetes accounted for 24 per cent of overall spending.
  • Cancer spending increased by 10.8 per cent and ranked number seven by overall spend in 2017, up from 10 in 2016.

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