Specialty drug spend unsustainable: report

The average annual drug treatment cost for each patient with cancer drug claims is $10,690, which is approximately 14 times the national average of $765 per patient in Canada.

This will require employers to increase the funding for drug benefits or modify the way drug plans are structured for their employees. Drug benefits costs are expected to increase in the future primarily driven by the continued growth in utilization of specialty drugs.

“New specialty drug treatments are making a real difference in the lives of patients, but the high cost of some of these drugs creates difficult decisions for employers that have to decide which medications to cover,” says Michael G. Biskey, president of Express Scripts Canada.

Another key finding from the report is that spending on traditional prescription drugs declined by 1.2%. This downward trend is driven almost entirely by the availability of generic drugs coupled with reduced generic prices imposed by provincial drug reform.

And up to $1 of every $3 spent on drug benefits is wasted due to poor patient decisions. Patients continue to use more expensive medications when less expensive alternatives will provide similar health benefits. Patients also use expensive distribution channels, use less-than-optimal dispensing intervals and often fail to take prescription medication as prescribed. This results in significant health consequences for patients and enormous financial tolls on benefits providers.

The report also finds that traditional prescription drug benefit management tools are limited in their ability to drive better patient decisions, which has resulted in unnecessarily high costs and a cost shift from employer to employees.

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