Specialty drugs: the ones to watch
Specialty drugs offer patients many therapeutic benefits, and in some cases introduce treatment where no treatment was previously available. As more specialty drugs come to market, plan sponsors will need to be aware of the benefits and costs of these effective but expensive treatments, particularly when making decisions about their drug plans.
Better results. Bigger price tag.
In May of this year, ESI Canada® released the ESI Canada 2008 Drug Trend Report. This annual report looks at drug utilization and the drivers of trend in the Canadian prescription drug market based on ESI’s bank of data. The 2008 ESI Canada drug trend report is based on an historical analysis of 65 million drug claims submitted for 7 million Canadians totaling $3 billion.
The report found many of the new drugs being introduced to the market are specialty drugs, products that will have a significant impact on plans and plan members in the coming years. Specialty drugs are therapies used to treat specific, chronic and/or rare
diseases such as rheumatoid arthritis, cancer, multiple sclerosis, HIV/AIDS, hepatitis, and others. Specialty drug treatments often involve careful monitoring by doctors, require frequent adjustments to the dosages, special handling or administration, and usually come with a high price tag.
Unique qualities of s p e c i a l t y m e d i c a t i o n s ✓ T h e y f r e q u e n t l y r e q u i r e adjustments to the doses b e i n g t a k e n ✓ T h e y c a n c o s t m o r e t h a n $ 5 0 0 f o r a 3 0 - d a y s u p p l y ✓ T h e y i n v o l v e s p e c i a l i z e d h a n d l i n g a n d a d m i n i s t r a t i o n ✓ C l o s e p a t i e n t / c l i n i c a l monitoring is required
Specialty drugs and the bottom line
Although specialty drugs represented less than one per cent of claims processed by ESI Canada in 2008, they accounted for almost 15 per cent of drug spending by private plans. Spending on specialty drugs is increasing at 17 per cent each year, compared to only three per cent for all other drugs.
ESI Canada® is a registered trademark of Express Scripts Inc.
ESI Canada says that when the specialty drugs already on the market are grouped together (approximately 1,100 Drug Identification Numbers or DINs), along with the more than 125 that could enter the market in the coming years, they“…will put significant pressure on plan sponsors.” Although the use of generic drugs will slow the increase in drug spend over the next few years, ESI Canada predicts that the effect of new specialty drugs will push the average drug spend per claimant as high as $1,185 by 2018 (from $698 in 2008). This establishes specialty drugs as the key drivers of drug trend, and also makes specialty drugs the ones to watch in the coming months and years.
To mitigate their effects, plan sponsors are encouraged to consider implementing wellness programs that target chronic conditions through lifestyle modifications (diet, exercise, and others) in order to have a positive influence on both employee health and overall drug plan use.
Source: ESI Canada® 2008 Drug Trend Report