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August 01, 2012
Specialty drugs drive up plan costs

Specialty drugs continue to drive up drug plan expenses, and will continue to do so past 2015, according to latest data released in Express Scripts Canada’s 2011 Drug Trend Report.

According to the pharmacy benefit manager, while specialty drugs comprised less than one per cent of all drug claims, they accounted for 20 per cent of total drug spending in 2011. That percentage is expected to increase to the 25 to 30 per cent level as new medications are approved and released to the marketplace.

Express Scripts Canada defines a speciality drug as "an injectable or non-injectable drug that is typically used to treat chronic, complex conditions." It must also have one or more of the following characteristics:

• a requirement for frequent dosage adjustments and intensive clinical monitoring to decrease the potential for adverse effects and increase probability of improved outcomes;

• a need for intensive patient training and compliance assistance;

• limited or exclusive product availability and distribution;

• specialized product handling or administration requirements; and

• a cost of more than $500 per month per prescription.

Biologic drugs would fall in this category.

The 2011 report notes that, in 2011, 51 new drugs entered the Canadian marketplace. Of those, 17 were specialty medications. The most noteworthy in terms of potential costs to drug plans were:

Prices for the other six specialty medications have not been published.

These new and expensive drugs may have positive impacts on the lives of claimants and this may lead to reduced absenteeism and disability claims, higher work productivity and a happier work force.

While these new medications are designed to treat severe or relatively rare medical conditions, common illnesses, such as high blood pressure, infections and inflammatory conditions continue to dominate claims activity in terms of both number of claims and costs, Express Scripts reports. These are highlighted below:


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