Reimagined drugs for new uses expected to have high impact on drug plans

Seven of the 10 therapies highlighted in the TELUS Health 2025 Drug Pipeline report will likely have a high or medium budget impact on private drug plans. Some drugs are new, while others are newly developed from older formulations for new purposes – at prices exponentially higher than when the drugs are used for their original intended uses.

The report looks at early-onset Alzheimer’s disease, plaque psoriasis, migraines, attention deficit hyperactivity disorder (ADHD), macular edema and weight management drugs. 

Alzhemier’s drugs 

“Alzheimer’s disease does not normally cross paths with private drug plans – that will soon change,” the report’s researchers write in a discussion about the first-ever disease modifying drugs that are due to arrive in Canada. These are designed for a small subset of patients diagnosed with young-onset Alzheimer’s, who will likely turn to their drug plans for coverage.

The Alzhemier’s drugs are expensive and not always recommended for coverage due to their limited effectiveness.

The drugs – Leqembi and Kisunla – are indicated for Alzheimer’s in its early stages, when cognitive impairment is mild. “Phase 3 clinical trials for both drugs showed disease-progression slowed by 27 per cent (Leqembi) or 22 per cent (Kisunla), on average. Put another way, disease-worsening occurred four to seven months later, on average,” they write.

The expected list prices for Leqembi in Canada is approximately $30,000 per year. The U.S. list price for Kisunla, not yet available in Canada, is approximately $32,000 USD for 12 months – about $46,000 in Canadian dollars.

In the United Kingdom, the country’s health technology assessment agencies have so far recommended against the coverage of the drug by the National Health Service (NHS), stating that “the reality is that the benefits are just too small to justify the significant cost to the NHS.” 

Exercising caution 

In Canada, they say both Health Canada and the Canada Drug Agency would appear to be exercising caution – almost two years have passed since Health Canada began its review of Leqembi when the agency generally completes reviews in just under a year.

New Alzheimer’s diagnoses could also be aided by new tools in the future. Where confirmation of an Alzheimer’s diagnosis currently requires a brain scan or spinal tap, a blood sample test can now be done in a doctor’s office – currently at a cost of about $2,100 per test.

In examining old drugs being repurposed for new uses, celecoxib, known as Celebrex (often prescribed for osteoarthritis at an annual cost between $150 and $700), is being repurposed in a new drug called Elyxyb for acute migraines at a cost of about $1,000 in U.S. dollars for six doses.

The report looks at the phenomenon also occurring in the development of ADHD medications using methylphenidate and at triamcinolone acetonide, a commonly prescribed corticosteroid at less that $3 per dose, which is being remarketed as Xipere for macular edema at a cost of about $2,400 per treatment in Canadian dollars.

For reference, the report also provides a table of new drugs by disease and indication, along with their expected costs. New generics and biosimilars are also listed by disease and indication.