Private drug plan spending increased 5.4 per cent, according to Express Scripts Canada’s annual drug trends report.

While up to a one per cent increase in private drug plan spending was anticipated, similar to the 0.6 per cent increase between 2018 to 2019; the report showed a decrease in the percentage of members who claimed, offsetting a significant growth in the cost per claimant and balancing out an increase in the cost per member.

Read: Specialty drug usage, traditional drug costs drive small rise in 2019 spending: report

The report attributed the increase in cost per claimant to a number of factors, including to fewer members submitting claims and higher costs associated with the coronavirus pandemic and specialty drugs. Costs per claimant decreased in cough and cold remedies (negative 60 per cent), medications used for infections (negative 28 per cent) and pain/inflammation (negative 19 per cent). As well, the report showed 30-days’ supply limits on maintenance medications lowered cost per prescription but increased the number of claims. And the onset of the pandemic led to stockpiling of chronic medications and conversion of 90- to 30-days’ supply claims across many provinces, resulting in additional claims and dispensing fees, noted the report.

The report also found chronic maintenance users now account for a higher proportion of the claimant base due to fewer acute-only claimants or new claimants for chronic disease medications. It revealed a 41 per cent increase in spend for all GLP-1 agonists, including semaglutide, a diabetes medication. And it noted flash glucose sensors for diabetes overtook traditional blood glucose test strips as spend of sensors increased by 60 per cent and the number of glucose-sensor claimants increased by 33 per cent. The average cost per claimant for flash glucose sensors was about five times more than the cost for a diabetes test-strip claimant.

Read: 2021 Drug Plan Trends Report: Diving deep into the pros and cons of drug pooling

Continued growth in specialty claims correlated with a rise in specialty drugs entering the market and approved drugs being used for new indications in 2020, said the report. Specialty drugs priced between $10,000 to $100,000 accounted for approximately 30 per cent of all specialty medications, 36 per cent of the volume and 70 per cent of the specialty drug spend; whereas specialty drugs priced below $10,000 accounted for 66 per cent of all specialty medications, 63 per cent of the volume and 22 per cent of the costs. Specialty drugs priced over $100,000 made up four per cent of specialty medications, one per cent of the volume and seven per cent of the costs.

In 2020, the overall spend increased by 23.3 per cent for specialty drugs over $100,000 due to an uptake in drugs used to treat cystic fibrosis, as well as to a significant increase in spend (57 per cent) on rare disease medications, said the report. And the overall spend for specialty drugs between $10,000 and $100,000 increased by 9.4 per cent, driven by an 8.8 per cent increase in spend for inflammatory conditions, 16.3 per cent increase for cancer and 43.2 per cent increase in spend for skin conditions. The overall spend in specialty drugs priced under $10,000 increased a little over eight per cent, driven by specialty medications for migraines.

Read: Growing use of specialty drugs putting pressure on plan sponsors: report

Last year also saw the top three therapeutic classes remain the same as in 2019 but with a rise in depression and a significant drop in infections, outlined the report. The rise in depression could be driven by the impacts of the pandemic and the associated isolation and financial stress, as claims per claimant for anti-depressants rose 10 per cent. Similarly, the drop in infection may be linked to public health restrictions imposed due to the pandemic, resulting in lowered risk of community transfer of infections in schools and workplaces. But the report noted the drop could also be attributed to accessibility issues or to people’s reluctance to see their health-care provider out of fear of exposure to the coronavirus.

Indeed, the report noted thousands of Canadians living with chronic diseases may have gone undiagnosed during the pandemic. According to the report, 2020 saw a significant drop in new claimants for chronic diseases like diabetes, cancer and depression due to accessibility issues or fear of exposure to the coronavirus. The report noted seeking care in the earlier stages for these and other conditions likely improves health outcomes and helps decrease the risk of disease progression and related consequences. In particular, delays in cancer screening and cancellation of surgeries could lead to more patients with more advanced disease and the need for newer more expensive drug treatment, rather than less expensive first-line therapies.

Read: Chronic disease, drug claims driving benefits plan costs: report

A return to “normal” and specialty drug influences will depend on many factors, noted the report, including the timing of coronavirus vaccinations and how quickly restrictions are lifted, as lockdowns are associated with fewer claims for acute medications, such as antibiotics and cough and cold remedies. It will also depend on whether the health-care system reverts to pre-pandemic capacity levels, an increase in new specialty drugs entering the market and existing specialty drugs being approved to treat a wider range of diseases as well as on acceptance of biosimilar transitioning policies and new biosimilars coming to market.