While biologic drugs can represent a significant percentage of a plan’s drug costs, a Green Shield report says they are not the only thing driving up costs. Of course, plan sponsors need to actively manage biologics as use continues to grow, but they need to look for other places to also control drugs costs.
Green Shield Canada’s Drug Study found that 5% of plan members account for a very large proportion of plan costs (43%). In fact, the top 20% of high-cost claimants account for 75% of costs.
Today, high-cost claimants are increasingly prescribed a biologic therapy for chronic diseases such as severe rheumatoid arthritis (RA), juvenile RA, Crohn’s disease, psoriasis and others.
Biologics do dominate the top DINs list, according to the report. Remicade is in the lead (biologic for RA and Crohn’s). Enbrel (for RA, ankylosing spondylitis and others) and Humira (RA, Crohn’s, psoriasis and others) are two other biologics in the top five. Both of these moved up in the list this year. And the total cost of biologics continues to rise from year to year: from 9.4% in 2006/2007 to 12.3% in 2010/2011. This is lower than the broader industry trend, which sat at 14.9% in 2011.
While biologics account for 21% of the costs attributed to the high-cost claimants, according to the report, only 9% of these high-cost claimants are actually taking biologics. So, says Green Shield about the report, the high-cost claimant group is actually dominated by plan members that are taking all kinds of prescription drugs (not just biologics) for conditions such as hypertension (61%), high cholesterol (52%), depression (51%) and stomach disorders (50%).