Plan Sponsor Week: Using analytics to monitor non-adherence, disease states

Plan sponsors have to move beyond benefits plan reporting and dig into analytics to better understand medication non-adherence and the top disease states affecting their workforces.

“Leveraging plan-specific data can help answer the fundamental questions needed to manage your benefits program,” said Shawn O’Brien, Telus Health’s principal of data enablement and drug, health, dental product roadmaps, during a session at Benefits Canada‘s 2020 Plan Sponsor Week earlier this month.

While reporting summarizes data from individual sources and can give plan sponsors insight into their past and present drug plan experience, analytics goes further, he said, by providing insights into future trends and drawing connections between separate sources of data to drive strategic decision-making.

Read: Mental-health conditions, specialty meds driving drug plan cost increases in 2019: report

Drug non-adherence is a key area for plan sponsors to watch as it accounts for a large percentage of overall eligible claims cost. Non-adherence is calculated using a medication possession ratio — the time between when a plan member refills their maintenance medication compared to the number of days’ worth they have.

Four of Telus’ top 10 drug classes by eligible amount were found to have significant non-adherence rates. Depression, which accounted for 5.1 per cent of total eligible claims for the organization’s book of business, had a 23 per cent non-adherence rate. And diabetes, the second-highest drug class, representing 10.6 per cent of total eligible claims, had a 24.8 per cent non-adherence. Two-thirds (65.8 per cent) of asthma patients were non-adherent, along with 16.2 per cent of patients taking cardiovascular and cholesterol medications.

“Taking drugs on time and as prescribed is critical to managing these diseases,” said O’Brien. “Often people that are on anti-depressants may start to feel better and they may skip doses, so there’s certainly reasons for non-compliance. You’ll see asthma has a very, very high non-adherence rate, but it also tends to have a seasonal component, which may explain why we’re not seeing regular fills.”

Read: Drug adherence an increasing issue for plan members, sponsors, finds survey

He also emphasized the need for plan sponsors to monitor their top therapeutic classes. “[That] can shed some light on where the burden of illness lies within your organization. For Telus’ book of business there’s poor adherence across several chronic conditions and those conditions are also present in the top 10 most expensive conditions.”

These therapeutic classes shouldn’t be examined in isolation, he added. For example, a deep dive on the diabetes therapy class showed diabetics taking at least one medication accounted for 4.92 per cent of Telus’ book of business and 17.9 per cent of all claims processed when including syringes, lancets and testing strips.

But upon further examination, claimants with diabetes also contribute heavily to other disease categories. The analysis found 13 co-morbid conditions associated with diabetes claimants. Cholesterol disorders and blood pressure issues were the most common, with more than 200,000 diabetic patients also prescribed medications for those two conditions.

“The point is, you need to look beyond the surface data,” said O’Brien. “Yes, the diabetes therapy class is one of the top as far as the overall percentage of paid claims under the benefits program. But when you consider the other conditions, a diabetes patient is responsible for a very high percentage of overall plan costs.”

All of the 2020 Plan Sponsor Week sessions are available on-demand at

Read: A look at the value of continuous glucose monitoring