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Data is key to delivering cost-effective benefit plans through COVID-19

June 19, 2020
By Dorian Lo

(NiiNew/Adobe Stock)

The rapid, global spread of COVID-19 has brought to life the importance of capturing data accurately, as well as managing data from disparate sources to create insights for clients and plan sponsors.

This is compounded by a complex and competitive marketplace where companies must continue to evolve their benefits programs to attract and retain top talent.

Affordable costs for employers are more important than ever before.

How can employers across Canada deliver cost-effective benefit plans during and after COVID-19?


While the data related to the crisis is ever evolving, we know that various provinces have introduced limits on days’ supply to protect against drug shortages which leads to more frequent prescription fills and a direct impact on prescription drug benefits costs.

The good news is that the year-over-year trend in claims volume is relatively consistent and the average dispensing fee across provinces are stable.

While a more broad-based analysis focused on the use of emerging COVID-19 treatment drugs, mental health, anti-infectives and opioids is on the way, a comprehensive overview of the use of prescription medications in the Canadian private sector that lays the groundwork of evolving trends and what’s to come is also vital.

Drug trend report lays foundation

Pharmacy benefits management group Express Scripts Canada recognizes this and leverages technology, innovation and data analysis to create better health outcomes for employees across Canada.

This knowledge helps our clients deliver affordable benefits programs to help manage costs for employers.

With the launch of this year’s 2020 Prescription Drug Trend Report, companies are provided with comprehensive research on the use of prescription medications in the Canadian private sector.

The report confirms that innovative solutions are the key to controlling the cost of prescription drug benefit plans for employers, especially at a time when we have entered an age of million-dollar-per-treatment drug launches.

This is underscored by the fact that high-cost specialty drugs make up 60 per cent of the total drugs in development.

Dr. Dorian Lo is president of Express Scripts Canada. (Submitted)

Benefits of diabetic drugs

Diabetes is a chronic condition that affects Canadians of all ages.

In fact, one in three Canadians are currently living with either diabetes or pre-diabetes and an estimated one million are living with undiagnosed type 2 diabetes.

The report reveals that additional benefits have been found for drugs in therapy classes like diabetes and there has been a higher use of more costly options in diabetic supplies, which can drive costs higher.

As the number of Canadians diagnosed with diabetes rapidly increases (more than 480 people in Canada are diagnosed with type 2 diabetes every single day) — this is a category to watch closely moving forward.

Specialty drugs on the rise

Specialty drugs are used for the treatment of complex conditions and they often require special storage, handling, monitoring and administration.

As a result, they are expensive — typically an expected cost greater than $10,000 annually.

As cancer treatment remains a primary pharmaceutical research focus and with more than 30 new rare disease treatments in the drug pipeline horizon, innovative solutions to combat this trend are necessary.

While most of these drugs are concentrated on a small group of claimants, companies should be mindful of this trend.

Medication adherence a costly issue

As many as 70 per cent of Canadians don’t take their medications as directed by their physicians and up to 26 per cent of prescriptions are never filled.

This is known as medication nonadherence and it affects the most prevalent chronic medical conditions, including high blood pressure, diabetes and depression.

This is a million-dollar issue for employers and can result in worsening health status, increased incidences of short-term leave, more hospital visits and avoidable health-care expenses.

Those employees who manage multiple conditions face unique challenges.

In fact, our data shows that 58 per cent of plan members using two to three medications are nonadherent to at least one medication, and 77 per cent of plan members using more than four medications.

Since medications don’t work if they aren’t taken correctly, ensuring employees are taking their medications as prescribed in the early stages of their condition can help prevent it from progressing.

Opioid crisis is a national emergency

In 2018 alone, 4,614 Canadians died from opioid-related overdoses.

However, many opioid users aren’t aware of the risks that come with taking opioids and need specific types of care. While one in five Canadians suffer from moderate to severe chronic pain and might take opioids to help ease pain, in cases of acute pain (for example: a back injury), the medication is intended for short-term use only.

The crisis drives Express Scripts Canada’s mission to make the use of opioids safer.

It begins with the understanding that curtailing opioid misuse requires a clinically-driven, pharmacy benefit management solution. Our Opioid Management Solution proactively manages opioid users — new and acute users, and short-term and intermittent users.

By limiting the “first fill” to a seven-day supply to ensure a safe start of short-acting opioids, the program realizes a nearly 32 per cent reduction in the average days’ supply for the new opioid-prescribed patients, which results in improved member care.

Considering this data, and the current climate and potential fallout created by the COVID-19 pandemic, lowering costs requires HR professionals to work with their benefits providers to ease the threat of rising costs and manage benefit plan sustainability.

Introducing the right solutions, such as medication adherence and opioid management solutions, will both help manage costs and see employees experience better health outcomes.

Dr. Dorian Lo is president of Express Scripts Canada.

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