Many Canadians living with asthma are experiencing poor control over their symptoms, impacting the workplace, said Anjila Arora, director of pharmaceutical benefits at Sun Life Financial Inc., during Benefits Canada’s 2023 Face to Face Drug Plan Management Forum.

Between 53 and 90 per cent of asthmatic Canadians meet at least one criteria for poor control over the condition. Poorly controlled asthma can cause permanent damage to someone’s airway and she noted people with poorly controlled asthma can also experience sleep disturbances that lead to difficulty concentrating during the workday.

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While many believe their asthma to be under control, surveys have shown people accept levels of control that fall short of what’s clinically appropriate. There can be a range of factors impacting someone’s level of control, from misunderstanding how to use their medication to deciding not to take it due to concerns about side effects or cost.

According to Sun Life’s block of business data, asthma and chronic obstructive pulmonary disorder (48 per cent) experienced the most significant growth in number of claimants between 2021 and 2022. The category also had the highest growth in spend across drug categories in 2022, while asthma and COPD drug Symbicort rose to the No. 6 spot among the top 10 traditional drugs by spend, from the No. 9 spot in 2021.

Arora said this growth could be explained by a few factors, including claimants’ exposure to highly contagious respiratory infections that can trigger asthma symptoms, including the flu, the coronavirus or the respiratory syncytial virus. It could also be partially explained by the recent approval of Symbicort for a new indication as a reliever medication for asthma, in addition to already being a controller medication. “The significance of this is that there could be a shift in what we see in prescribing habits and it has a higher cost compared to other reliever medications.”

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However, she noted that a combination controller-reliever medicine is recommended by asthma treatment guides for patients with adherence issues. While controller medications should be taken every day to reduce symptoms and prevent long-term damage, non-adherent asthma patients tend only to use reliever medications, which can provide immediate relief in a flare-up but don’t treat the underlying issue.

Arora suggested plan sponsors adopt mandatory generic substitution and pointed to data on Ventolin, a brand-name reliever drug, as evidence of its effectiveness: while the drug made up 40 per cent of unique asthma claims, it represented just 6.1 per cent of Sun Life’s asthma drug spend due to generic substitution. Prior authorization can also be valuable for high-cost specialty drugs used to treat severe forms of asthma.  

She also recommended making vaccine coverage a part of benefits plans to reduce the impact of viral respiratory diseases, as well as digital health and wellness platforms that provide on-demand access to care for plan members. Some virtual pharmacies have asthma support programs that identify and help the patient manage their triggers, provide medication adherence support and more.

Read more coverage of the 2023 Face to Face Drug Plan Management Forum.