Portrait of Person with Diabetes: Understanding the full cost impact.

TELUS Health Annual Conference 2020

Plan members with diabetes have a much bigger impact on private drug plans than originally suggested by claims data. Furthermore, a deep dive into the data builds a compelling case for investment in behaviour change support as a way forward to manage costs and improve health outcomes.

These are among the findings presented by Jason Kennedy, Director, Health Business Consulting, TELUS Health, during his national webinar presented live on May 20. A recording of the webinar is available below.

Drugs to treat diabetes already rank second in the top 10 list of drug classes by eligible cost. In 2019, diabetes drugs accounted for 10.6% of total eligible amounts considered for coverage by private drug plans (following drugs for rheumatoid arthritis, which accounted for 12.1% of eligible amounts). In terms of number of claimants, 4.9% of all claimants were responsible for the 10.6% in costs for diabetes drugs.

While these numbers already indicate the large impact of diabetes on the drug spend, a closer look from the perspective of the patient paints an even more compelling picture:

  • Approximately 60% of people with diabetes submitted claims for drugs to manage blood pressure and cholesterol in 2019; about 20% submitted claims for drugs for depression.
  • When all other claims are factored in, diabetes claimants’ share of total eligible costs climbs to 18.2% from 10.6%.
  • Each claimant takes an average of seven medications, resulting in an average annual cost of $3,020. About half of the costs are for drugs to treat diabetes and half are for other conditions.

Moreover, an analysis over time shows that costs steadily increase for plan members with diabetes—yet not necessarily for drugs to treat diabetes. “The biggest driver of costs, in many cases, appears to be everything else they are taking outside the diabetes category,” said Kennedy.

Adherence to medications is a significant challenge, he emphasized. The refill rate for medications is one way to indicate adherence levels, and plan members are considered non-adherent when they have a medication possession ratio of 80% or less. Plan members with diabetes have an medication possession ratio of 74%. “Inherently they are non-adherent,” noted Kennedy, who added that this is understandable given the number of medications and the complexity of managing multiple conditions.

The result can be a downward spiral that sees patients taking even more medications to try to reach targets for blood sugar levels, blood pressure and cholesterol. “These are troubling indicators given what we know about the progression of the disease and the risk factors,” said Kennedy. In some cases, the cost for these additional medications when not taken correctly “can be viewed as an unproductive cost.”

“As much as we have ample cost containment measures [at the claims level], these don’t address the individual,” said Kennedy. “A lot of themes for treatment focus around prevention and healthy behaviour interventions, introduced as soon as possible…. There is a big change management curve for a lot of these patients.”

During his presentation, Kennedy walked through scenarios in which private health benefit plans can support behaviour change, and how interventions can be targeted to different cohorts of patients. As well, he spoke of the use of digital tools for cost-effective scalability.

See below for the complete recording of the webinar.

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