Specialty drug usage, traditional drug costs drive small rise in 2019 spending: report

Private drug plans saw a slight uptick in costs in 2019 due to the increased use of specialty drugs and higher price points for traditional medications, according to Express Scripts Canada’s annual drug trends report.

The report found private drug plan spending per claimant increased one per cent over 2018’s figures. Plans’ annual spend per claimant on specialty drugs — representing just two per cent of claims — increased by 2.8 per cent and spend on traditional medicines per claimant increased 0.1 per cent.

“While the overall private drug trend is up one per cent, prescription drug benefits continue to be threatened by the growing use of very high-cost specialty drugs,” said the report. “Sustainability depends on benefits management solutions that translate into lower costs and improved health outcomes.”

Read: Growing use of specialty drugs putting pressure on plan sponsors: report

The increase in traditional drug spend reversed a 1.8 per cent decrease in 2018, which was due to a 7.2 per cent increase in spending on diabetes drugs and a 16 per cent increase in diabetes supplies and monitoring technology. However, Ontario’s short-lived OHIP+ program and the pan-Canadian Pharmaceutical Alliance price negotiations helped to keep costs lower, noted the report.

Looking forward, Express Scripts said it expects higher-cost asthma medications that are recommended as first-line therapy to replace lower-cost inhalers, as well as the increased adoption of flash glucose monitoring systems over traditional glucose monitoring test strips for diabetes patients to drive an increase in spending on traditional medications.

While private drug plans spent more on specialty medications in 2019, that amount was lower than 2018’s 6.9 per cent increase. The rise was largely due to higher use of existing specialty drugs with new indication approvals, such as Humira and Cimzia, and the launch of oral oncology medications that have shifted cancer treatment costs to private plans. Other contributors were specialty medications for treating asthma. And, the emergence of provincial programs for biosimilars, such as British Columbia’s mandatory substitution program, helped to offset these pressure points.

Read: B.C. government says expanding biosimilars will save nearly $100 million over three years

The report also noted new Patented Medicines Pricing Review Board regulations that will remove the United States and Switzerland as comparator countries as of July 1, 2020 are expected to help drive specialty medication prices lower.

Specialty medications are dominating the drug pipeline, making up 60 per cent of all medications currently in development, it said. The vast majority are for cancer treatment, with 50 per cent designed for oral administration outside of a hospital setting, and some gene therapies. As well, more than 30 new rare disease treatments are in the pipeline.

“Personalized gene therapies for cancer, high-priced drugs for common conditions and life-saving, high-priced therapies for rare diseases will put continued pressure on the spending trend,” said the report.

However, it noted six biosimilars for three types of cancer and one osteoporosis drug were launched in 2019, and 15 are currently under review by Health Canada, for inflammatory conditions, cancer and blood disorder indications.

Read: New genetic therapies in cancer treatment could impact benefits plans

Looking at therapeutic classes, private drug plans spent the most on inflammatory conditions (12.9 per cent), followed by diabetes (nine per cent), asthma and chronic obstructive pulmonary disease (5.3 per cent), high blood pressure (five per cent), depression (4.8 per cent) and cancer (4.5 per cent).

Inflammatory conditions are a class dominated by specialty medications, noted the report, and the increase in spending was driven by new biologics such as Skyrizi and new indication approvals for drugs such as Humira and Cimzia.

The report also found skin conditions made up three per cent of private plans’ drug spend, with the highest increase in spending. It noted this was due to the increased use and expanded indication of Dupixent to treat atopic dermatitis.

The report said it expects spending on migraine treatments to increase, as utilization grows for calcitonin gene-related peptide inhibitors, which are 30 times more expensive than traditional preventative medications. While rare disease costs are expected to increase in 2021, utilization will remain low.

Read: 2020 Drug Plan Trends Report: Developments, data and design