There was a solid interactive element to Benefits Canada’s Face to Face Drug Plan Management Forum as participants took part in a live-polling session on the various myths surrounding drugs.
Are prescription drugs the same price at all pharmacies? Are biosimilar and biologic drugs the same thing? Those were among the issues the audience weighed in on as a panel of experts addressed some of the common myths behind the questions:
Prescription drugs are the same price at all pharmacies
According to the audience poll, 94 per cent believed that to be a myth. “It’s definitely a myth,” said Kevin Wong, manager of pharmacy services at Telus Health. “When you look at a prescription cost, there are three main components: drug cost, the pharmacy markup and the dispensing fee. But there are more variables that go into that actual prescription cost: plan management strategies by insurers, where you live, the pharmacy chain and the type of drug as well.”
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And while Wong and the other panellists are aware of those costs, that may not be the case for plan members. But Godfrey Mau, director of pharmacy benefits at Manulife, thinks that knowledge will eventually trickle down to the plan member. “Think about some of the tools insurers are developing: for example, apps to comparison shop,” he said. “As more of these types of digital tools become available, plan members will hopefully become more conscious shoppers.”
Biosimilar drugs and generic drugs are the same thing
While 96 per cent of audience members said that was a myth, for Jim Keon, president of Biosimilars Canada, that’s not the most important question. “The most important question is are they the same as the originator biologic? They are approved by Health Canada as being similar and approved to work as effectively and can be brought into your drug plans,” he said.
Joe Farago, executive director for health-care innovation at Innovative Medicines Canada, pointed to Health Canada’s guidelines for biosimilars, which state: “Authorization of a biosimilar is not a declaration of pharmaceutical equivalence, bioequivalence or clinical equivalence to the reference biologic drug. Clearly, at this time, they’re not seen as completely interchangeable or equivalent by Health Canada or else they would have suggested such.”
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Durhane Wong-Rieger, president and chief executive officer of the Canadian Organization for Rare Disorders, weighed in on the patient perspective. “The challenge for us, in many cases, is drug plans and countries are treating biologics as if they were generics,” she said. “So they’re taking patients who are stabilized on biologics and putting them on biosimilars, without necessarily having a good reason for it from the point of view of patients.”
Specialty drugs are driving up private drug plan costs
A majority of the audience (79 per cent) called that a fact, a point of view John Herbert, director of strategy, product development and clinical services at Express Scripts Canada, agreed with.
“We do see double-digit growth within specialty drug spend each year. Over the past seven years, spending on specialty medications has grown from about 15 per cent of total drug spend to upwards of 30 per cent of total drug spend,” he said. “But I’m not surprised some say myth because it’s not the only piece that is driving up costs. Specialty drugs make up only about two per cent of overall prescriptions.”
New drugs are better than older ones
Eighty-seven per cent of audience members called that a myth.
“When you look at how you determine if a new drug is better than an older drug, it comes down to that economic evaluation,” said Wong. “We rely on CADTH [Canadian Agency for Drugs and Technologies in Health], as well as the formulary committees at private pharmacy benefits managers to review and provide managed care formularies so you know those drugs are assessed.”
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But Wong-Rieger questioned what it means to say a drug is better. “When we’re looking purely at the economics, when we’re looking purely at entities like CADTH, are they really capturing what it means to be better to patients? A drug that you can use once every three months, as opposed to daily, is not necessarily going to give you better outcomes but is going to be better from the patient perspective. We don’t necessarily take into consideration what it means to the patients,” she said.
“We’ve seen in the past that the heavy marketing of new drugs often results in the use of some drugs in therapeutic classes that are no better than existing medications,” said Keon. As a result, he suggested drug plan managers should develop formularies to manage their costs and look at the efficacy of new drugs compared to older ones.
Drug plan cost-management solutions result in restricting access to drugs
While just over half (51 per cent) of the audience thought that was a myth, Mau said it depends on the solution under consideration.
An example, he noted, is preferred pharmacy networks for specialty medications where the issue isn’t about restricting access but controlling some of the other cost elements.
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The more important question, he suggested, is whether continued unrestricted access is what plan sponsors want to be providing in their drug plans. “There are certain medications that may not necessarily deliver any additional value but are much more expensive than the other options within that category. Does it make sense to continually reimburse those drugs or does it make more sense to provide broad access to the necessary medications so we can continue to fund those really innovative drugs that are changing people’s lives?”