The Express Script report is 86 pages and although it makes for great reading, the skinny essentials were noted on the 1st couple of pages of the report (excerpted below):
Executive Summary / Trends and a Glance
According to the Express Script report, prescription drugs play an important and increasingly essential role in reducing the impact of disease on individuals and families as well as on Canada’s healthcare systems and economic productivity.
At the same time, drug cost inflation is a growing burden for both private and public healthcare plans, as well as for Canadian families. Overall, prescription drug spending in Canada’s private sector has increased nearly fivefold in the last 20 years, from $3.6 billion in 1993 to $15.9 billion in 2013.
Express Scripts Canada’s extensive drug trend analysis is designed to provide insurance carriers, third party health benefits administrators, and plan sponsors with comprehensive data on the use of prescription medications in the private sector in Canada. These reports provide statistically relevant analysis based on millions of drug claims for more than seven million Canadians.
Plan sponsors that provide health benefits to their employees continue to deal with a rapidly shifting pharmacy landscape. In the face of increasing costs for traditional drugs, and the financial risk associated with specialty drug claims that can reach into the hundreds of thousands of dollars per treatment, many plan sponsors have shifted prescription costs to plan members. While this provides some protection from the cost inflation that continues to be a drag on the productivity and profitability of Canadian companies, it may also contribute to higher rates of non-adherence as prescription costs increase, potentially worsening health conditions and lessening productivity while increasing absenteeism and long-term disability costs. In addition, higher co-pays make benefit plans less attractive to members, making it more difficult for companies to attract and retain the most talented employees.
2013 Drug Trends At a Glance
- Specialty spend more than doubled in six years
o Double-digit annual increase expected to continue in future
- Poor patient decisions are driving waste
o Up to $1 of every $3 spent on drug benefits is wasted
o Waste made worse through gaps in care
- Behavioural science required to drive better patient decisions
o Better decisions have led to lower costs and healthier outcomes
- The national average annual drug spend per claimant increased by 1.3% to $765, reverting to an upward trend following a slight decline of 0.73% in 2012. This modest increase is consistent with the flat trend observed over the last four years.
- Large increases in specialty spend are being offset by provincial generic drug price reforms as well as patent expires.
- Traditional drugs represented 98.7% of claims and 76% of spend; specialty drugs represented just 1.3% of claims but 24% of spend.
- Specialty spend continues to grow as a percentage of total drug spending, steadily increasing from 13.2% in 2007 to 24.2% in 2013, primarily driven by high treatment costs and an increase in utilization.
- Traditional drug spend underwent a negative trend of 1.2% in 2013, with increased utilization offset by a reduction in the cost per script.
For over 20 years, Chris Pryce of Human Capital Benefits has been advising employers on all aspects of managing employee benefits programs and related products. If you have any questions, you can contact Chris at 416.924.8280 or by email at firstname.lastname@example.org