Tremendous changes in both the pharmaceutical and healthcare landscapes mean that climbing drug costs are inevitable, warned Carlyn Volume–Smith, Alberta Blue Cross Benefits Services senior manager. From new and innovative drug products to cutting edge technologies in emergent care, people are living longer with complex health conditions for which drug therapy will be the mainstay of treatment.
The pharmaceutical industry is continuing to come out with new and innovative drugs to help people live healthier lives—but all of this comes at a cost.
“Generic savings are over. Drug costs will go up, and the industry will see more questions about the sustainability of drug benefits plans,” Volume-Smith said. “The current reality is not tenable over the long term.”
The percentage of individuals with chronic conditions—such as diabetes, depression, high cholesterol and cardiovascular disease—is rising. Although Alberta Blue Cross has found that the cost per claimant has remained relatively stable over the past four years, increasing by a modest 3% from 2011 to 2015, the absolute number of claimants as a percentage of total members continues to rise, meaning that a higher percentage of its members are taking medications
For conditions treated with specialty drugs, the situation is a bit different. “Our spend on specialty drugs is accounting for a higher percentage of total spend as both the costs of the medication increase and the number of members taking these drugs also increases.”
In the end, Volume-Smith believes that taking action to ensure appropriate use of specialty drugs and increasing use of the existing industry tools, such as wellness programs and product listing agreements, will benefit both plan members’ health and the workplace as a whole. According to the Conference Board of Canada, for every dollar spent on medications, $2 in downstream health costs is saved—so optimizing these strategies will help ensure patients are receiving the greatest benefit possible.
With regard to specialty medications, Volume-Smith said it’s important to determine the following:
- Is the patient getting the right drug?
- Are you treating the patients at highest risk?
- Has the drug been prescribed with best practices and evidence-based medicine?
She believes plan sponsors, clinicians, pharmaceutical manufacturers and patient advocacy groups need to work together collaboratively to come up with solutions to better manage expenses, while still obtaining the benefits that plan members require.
All the articles from the event can be found in our special section: 2015 Calgary Drug Trends Summit Coverage.