An aging population and a trend towards costly drugs entering the market are driving benefit plan costs higher, but pharmacists can play a key role in helping to ensure plans remain sustainable, according to Barbara Martinez, national practice leader of drug benefits solutions at Great-West Life Assurance Co.
As Martinez told attendees at the recent Pharmacy Solutions in Drug Plan Management forum in Toronto, drugs are a frequently claimed benefit, with 82 per cent of plan members making a claim within a 12-month period. Pointing to data from Great-West Life for 2015/16, she noted the annual amount covered per plan member increased six per cent in comparison to the previous year.
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Older age bands have been a significant factor in the cost increases, with the average drug expenditure of a 57-year-old plan member coming in at more than 2.5 times that of a 32-year-old.
In addition, Martinez noted, plans are facing a drug landscape that has changed dramatically since 2012.
“Five years ago, we were talking, and very concerned about, the introduction of an expensive new drug called Soliris. It was treating a rare disease but it was $600,000, and we really had never seen a drug coming out at that kind of cost before. At that time, biologic and specialty drugs were 15 per cent of total spending on our drug plans.”
Soliris now looks inexpensive when compared with a new drug like Strensiq, said Martinez, noting the approximately $2.5-million cost to treat a rare condition that individuals are often diagnosed with in their youth.
“And in today’s world, biologic and specialty drugs represent 29 per cent of total spending on our block, so they’ve pretty much doubled in the last five years.”
Biologic and specialty drugs, Martinez noted, aren’t just for rare conditions anymore but will increasingly apply to more common, chronic conditions at a much higher cost than their predecessors.
“So that has us very concerned about the sustainability of drug plans,” she said.
As such, Martinez suggested the pharmacist’s role is evolving from one of managing price, through measures such as generic substitution, to helping control costs, through disease management and improving productivity.
To help manage plan costs, pharmacists can implement chronic disease programs, assist with pain control and undertake targeted medication reviews, Martinez told attendees.
They can also play a role in engaging employees through social media, formulary management and improving productivity through pharmacogenetic testing, she noted.