2019 Drug Data Trends & National Benchmarks Report.

Trends in the health and benefits landscape.

The 2019 TELUS Health Drug Data Trends and National Benchmarks Report (TELUS Health report) comes just 100 days before this fall’s federal election. For most Canadians, the pre-election period is a time to understand the key issues, policy positions and promises from the various political parties. One of these key issues is healthcare, a growing part of the conversation.

Canadian politicians and policymakers have been debating the merits and challenges of prescription drug coverage for decades. While those on one end of the policy spectrum consider government funded, universal coverage as the preferred model, others have identified more of a needs-based approach. An example of how political differences impact Canadians was clearly evident in 2016 with Ontario’s OHIP plus policy coverage implementation for the 0 to 24 age patient population.

The 2016 implementation was not without challenges as formularies shifted, leaving some patients to pay out of pocket for a drug that had once been covered by their private insurance. In April 2019, the newly-elected Ontario government scaled back OHIP plus, to reverse this policy to only cover children and young adults up to 24 years old without any private insurance. As in previous years, these types of policy and regulatory changes impacting the workforce will continue to be reflected in the TELUS Health report, along with major trends in private drug plan costs, utilization and design tool adoption.

One key finding in the TELUS Health report demonstrates that the cost for specialty drugs, including those used to treat cancer and rare diseases, have continued to rise and may soon surpass traditional medications. A needs-based approach where public payers shoulder the cost of these high-priced drugs could certainly relieve pressure on employer-sponsored benefit plans. However, patients will need reassurance that they will receive the best treatments and therapies, and continue to enjoy a quality of life should such a model come to fruition.

The most recent policy development came in June with the Advisory Council on the Implementation of National Pharmacare’s delivery of its final report, “A Prescription for Canada.” While only advisory at this point, the council report calls for a detailed national strategy for funding expensive drugs for rare diseases by 2022. This, and the commitment in the 2019 federal budget of $500-million per year, beginning in 2022, to pay for expensive drugs for rare diseases represents a distinct change in healthcare funding in Canada.

Another key finding of the TELUS Health report shows that while there is an increase in use of biosimilar medications (alternatives to first-on-market specialty biologic drugs which are made or contain living organisms) in some disease areas, others still lag behind. To encourage use of these innovative medicines, this spring, the British Columbia government became the first public payer to implement a mandatory switching policy for biosimilar drugs, dramatically increasing the focus on the use of these medications. Policy changes like these are expected to drive drug costs down and help to build a more sustainable system. In turn, governments are signaling the use of these savings for investment in other treatment areas.

Change brings opportunity and in light of these shifting policies, we as an industry have an opportunity to take a closer look at what the claims data is telling us. Big data exists and we have the tools to analyze and predict in ways that have not previously been done. Let’s use this capability to make informed decisions and build plan designs that fund broader health and wellness initiatives, integrate seamlessly with public funding and help garner the best possible health outcomes for the workforce of today, and the future.

As with any change there is no doubt that many will be having conversations around boardroom tables, examining trends and debating the impact of these major policy shifts on business, private insurance, patients and health providers. I encourage each and every one of us to reach out to our trusted partners and take the time to study the data, contemplate courses of action and determine directions that begin to build out the view of a total health statement for Canada’s workforce.

Related article: Plan sponsors using generic substitution, co-payments to curb drug plan costs: report (Benefits Canada)

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