2020 Drug Plan Trends Report: Developments, data and design

The growth of gene and cell therapies are raising significant questions among private payers about who bears the responsibility for the costs of these treatments, says Tim Clarke, president at TC Health Consulting Inc.

“One issue is whether this is going to be paid for by public health or if it’s an employer health issue. Gene therapy is a great example of the fact that it’s more complicated than just a drug.”

A new report by the Patented Medicine Prices Review Board found there’s a growing number of novel gene and cell therapies that are expanding to larger patient groups. It noted a gene therapy used in the treatment of cancer, approved by Health Canada in February, is among nine medicines with forecasted global annual revenues of more than US$1 billion by 2028.

Read: 2023 Drug Plan Trends Report: How the repercussions of the pandemic are trickling down to drug plans

“I think the biggest impact from a . . . group insurance perspective is that it’s not the cost in aggregate; it’s the risk of one person having an orphan disease or needing gene therapy,” notes Clarke. “It only takes a small number of people to create a significant cost. To me, the report shows risk management and pooling are going to become a more important issue going forward. I think we’re going to see more of a need for collaborative efforts between public and private health to handle some of these developments.”

In 2022, Canada’s pipeline contained more than 9,000 new medicines in various stages of clinical development, according to the report, compared to just under 8,500 the year before, with the number of drugs in the pipeline increasing by an average of 11 per cent per year since 2018.

Oncology continued to dominate the therapeutic mix of Canada’s drug pipeline in 2022, with cancer treatments representing nearly 30 per cent of medicines in all phases of clinical trials. Treatments for infectious diseases held the second largest share of the pipeline at 15 per cent, due to an increase in medicines to treat the coronavirus.

Read: Specialty drugs accounting for smaller portion of total eligible claims amount: report

As of last September, 550 vaccines and therapies were undergoing clinical evaluation globally and Health Canada was reviewing 14 new and supplemental drug submissions for the prevention and treatment of the coronavirus.

“I don’t see these developments having a major impact on employers, mainly because public health has taken a large role in [coronavirus] vaccines,” says Clarke. “However, it does stimulate a conversation for employers as to whether they should be covering vaccines as a category more broadly.”