May 1, 2019

Health Care Trends

Each year the major drug plan providers give us feedback on trends for the year and predictions for the next.  Specialty drugs remain a hot topic.  Specialty drugs are not just those to treat rare conditions – they are typically drugs that:

  • cost over $10,000/year;
  • require special handling – storage, administration, preparation, etc.;  and
  • may include a complex treatment plan
Ten years ago, it was fairly uncommon to see such a drug hit a plan.  However, as specialty drugs expand to more conditions with larger populations, it’s becoming more common.
Over half of the drugs that are currently in the pipeline (development and awaiting approval) are considered specialty drugs and most of those are to treat conditions that impact a large segment of the population – cancer and migraines.  It’s estimated that 565 Canadians are diagnosed with cancer every day(1) and 2.7 million Canadians reported being diagnosed with a migraine(2) .  Given these statistics, the impending impact to drug plans and stop loss limits could be high. 
If the trend towards specialty drugs continues as the current rate, spending on specialty drugs will outpace non specialty drugs in just seven years.(3)
The need for effective drug plan management is essential to maintaining the sustainability of drug plans.  It will require an expanded use of a combination of the following measures:
  • Managed Formulary – review of efficacy of drugs before approval on a plan. If the new drug is approved for coverage then it may also be subject to further restrictions such as step therapy and prior approval. 
  • Pharmacogenics – use of personal genetic information to provide the optimal drug therapy for the individual from the outset vs. an expensive trial and error process.
  • Active Drug Management – use of health care professionals to ensure the proper use of medication, adherence, and assistance with the management of side effects.
  • Government Intervention  – at the provincial and federal levels such as the development of a national pharmacare plan so as to better leverage drug prices on a volume basis.

(2)Prevalence of migraine in the Canadian household population
(3)Retrospective 2018 : data trends and national benchmarks, Shawn O’Brien, Principal, Business Intelligence, TELUS Health

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