The most recent Prescription Drug Trend Report from Express Scripts Canada shows that potentially more than 100,000 Canadians did not commence treatment in 2020 for chronic diseases or may be living with undiagnosed chronic diseases as a result of the COVID-19 pandemic. At the same time, the report also shows that overall private drug plan spending spiked 5.4 per cent in 2020, again in part due to pandemic concerns.

In the annual report, Express Scripts Canada says heading into 2020 analysts expected to see a one per cent increase in spending, similar to the 0.6 per cent increase observed between 2018 and 2019. As the pandemic played out, however, there was a decrease in the number of members who claimed, which offset significant growth in the cost per claimant. 

Increased claims and dispensing fees 

Express Scripts says part of the increase was driven by plan members stockpiling chronic medications at the start of the pandemic, followed by increased claims and dispensing fees that occurred as a result of many pharmacies converting 90-day prescriptions into 30-day supplies. They add that continued growth in specialty drug claims correlated with a rise in the number of specialty drugs entering the market, and the number of approved drugs being used for new indications.

“Specialty drugs continue to make up 60 per cent of the development pipeline,” says the report. “Drugs to treat rare disease and cancer (being) the largest contributors. In addition, the overall specialty spend in the more than $100,000 category was up 23.3 per cent from 2019. The extremely high prices of these breakthrough treatments mean that plan design must be equally innovative to protect plan sustainability.” 

Specialty drug trends 

The report also examines drug trends in depth, including trends in diabetes drugs, specialty drug trends, including a list of top specialty drugs being used, most common diseases and the highest cost medications in each segment. It provides a spending breakdown by therapeutic class (inflammatory conditions, diabetes and asthma or COPD remained in the top three for spending, while Express Scripts observed a rise in depression spending and a significant drop in the spending on drugs to treat infections), examines trends in the pharmacy space, looks ahead at the new drugs becoming available, and provides and overview of current legislative and judicial reviews affecting drug plans. The report also includes discussions about identifying at-risk opioid users and detecting non-adherence.

A significant drop in new claimants 

Most notably, the company says “2020 saw a significant drop in new claimants for chronic diseases like diabetes, cancer and depression. This drop in new claimants suggests there could be a growing backlog of members who, for a variety of reasons, are not necessarily seeking treatment for their conditions.” 

The company’s analysis of declines in new depression, diabetes and cancer drug claims suggests that more than 100,000 Canadians have not commenced treatment for depression, more than 20,000 have not commenced treatment for diabetes and more than 10,000 have not commenced treatment with medications used to treat cancer.

“Along with stay-at-home orders, conservation of critical healthcare resources and general population fears, non-critical medical resources are seeing significant drops in those seeking medical attention for many chronic conditions,” writes Dr. Dorian Lo, president of Express Scripts Canada. “This trend is a cause for concern.”