While the overall private drug plan spend per member increased by 4.3 per cent in 2021, fewer plan members submitted claims and the per-claimant cost grew, according to Express Scripts Canada’s latest prescription drug trends report.
Specifically, the percentage of plan members that made a claim decreased by 0.3 per cent last year while spend per claimant increased by 4.9 per cent. The year-over-year spend per plan member for traditional drugs increased by 3.7 per cent in 2021, driven primarily by the 4.3 per cent increase in spend per claimant. This is due, in part, to an increase in diabetes treatments (up 5.6 per cent) and migraine medications (up 6.8 per cent).
In addition, utilization increased by one per cent, driven by 62.3 per cent of all eligible plan members who had at least one claim for a traditional drug.
For speciality drugs, the year-over-year spend per plan member increased by 6.8 per cent in 2021. The primary driver was utilization, noted the report, with a 0.1 per cent increase in plan members making specialty drug claims. The trend was driven by an 8.3 per cent increase in claimants for treatments of inflammatory conditions and a 4.8 per cent increase in claimants for drugs used to treat multiple sclerosis. This was offset by a 0.7 per cent decrease in spend per claimant for specialty drugs.
For the year, the top two therapeutic classes were the same as in 2020, led by inflammatory conditions, which made up 13.3 per cent of overall spend, and diabetes, which made up 10.6 per cent of overall spend. However, the spend on depression medications jumped from 4th to 3rd place, with 5.1 per cent of overall spend. And skin conditions saw a significant increase, from 11th place to 8th place since 2020 and making up 3.2 per cent of overall spend.
For inflammatory conditions, costs were driven almost entirely by an 8.3 per cent increase in claimants, according to the report, while the growth in diabetes was a result of a 9.4 per cent increase in the number of claimants. Drug spend for depression also continued to grow with the primary driver attributed to a 9.1 per cent increase in claimants in 2021.
The spend for anti-obesity drugs increased by 23 per cent due to a 22 per cent increase in claimants, which is much greater than the two per cent increase in spend in 2020.
Although drug therapy isn’t the only solution for weight reduction, coverage for these drugs seems to be limited, noted the report. “The small proportion of claimants may be due to a variety of factors, such as the small number of plans that provide coverage for anti-obesity medications, the shortage of health professionals who specialize in obesity care and the potential stigma with seeking anti-obesity treatment.”