Trends in medication management in Quebec.

TELUS Health Annual Conference 2020

A careful examination of the clinical trends of the drug market is crucial to fully understanding its variations and perspectives. What are the new products in demand? What trends are we seeing with the key health conditions of Quebecers? What is the impact of the latest legislative changes on the role of pharmacists and health insurance programs?

Carole Desrosiers, Pharmacist Consultant, carried out this analysis and presented it in the webinar Évolution du marché des médicaments (Trends in medication management) held online on May 21.

This article is an overview of the many topics covered in the webinar. Watch the video recording at the end of this article.

Clinical trends

The costliest health conditions in TELUS Santé’s portfolio in Quebec have changed little compared to last year. In 2019, frontline conditions such as inflammatory diseases, diabetes, narcotic analgesics and depression remained the most expensive in terms of total eligible costs. As a consequence of this evolution, the most expensive drugs are also substantially the same as for the previous year. However, a few changes stand out. For example, the growth of medication for diabetes, related, among other things, to more aggressive treatments for type 2 diabetes. Also, the increased use of FreeStyle Libre, a continuous glucose monitoring device, and new antidepressant drugs characterized by less frequent side effects. Furthermore, the overall evolution of the drug market has shown very slow growth in biosimilar drugs given the current reimbursement conditions of these drugs.

Innovations

Significant innovations in the treatment of a number of diseases have emerged during the year, some of which have had an impact on their market. Think of recent penetrations in the cholesterol-controlling medication market, a constantly evolving market, activated by the lowering of prices of certain products and the arrival of other more costly products that necessarily call for stricter criteria to control their use. Similarly, the migraine drug market is growing, benefiting from very effective new inhibitors successfully administered to patients disabled by severe migraines. Until recently, obesity, for its part, was an underdeveloped market, despite its high morbidity factor, because it was limited by a drug with a number of side effects. New products with fewer side effects have arrived on the market, generating a certain growth, but limited by the fact that few plans cover these drugs.

Drug shortages

The globalization of markets in the pharmaceutical industry and the undeniable importance of China in the manufacturing of active ingredients weaken the secure availability of stocks. Major events, such as plant contaminations or a pandemic whose confinement measures substantially reduce the movement of manpower and productivity of plants, are at issue and the consequences are thus globalized. The COVID-19 pandemic, which originated at the heart of the Chinese industrial pharmaceutical area, is a good example of the impact of market globalization on increased drug shortages in pharmacies.

Legislative changes

On the legislative side, implementation of the national drug insurance plan was delayed due to different measures related to the COVID-19 pandemic. The Quebec government once again expressed its position in this regard, namely that this is a provincial area of jurisdiction and, as such, Quebec may use its right to opt out with full compensation, considering the recognized advantages of the Quebec provincial program as regards the number of drugs included on its list and the rapidity with which the province lists new drugs. Regarding the new regulation of the Patented Medicine Prices Review Board (PMPRB), it will be interesting to see its effect on access to new drugs and clinical research projects if this regulation comes into effect on July 20, 2020, as foreseen. (On June 1, 2020, the entry into force was delayed until January 1, 2021.)

Other significant legislative changes have taken place out west in British Columbia and Alberta, where the provincial governments introduced new reimbursement policies. Certain reference drugs, for which biosimilars exist, will no longer be reimbursed. In British Columbia, savings evaluated at $100 million over three years will be redirected to new treatments and additional provision of services to patients.

In Quebec, Bill 31, tabled by Minister McCann, to amend the Pharmacy Act to facilitate access to certain services, was adopted on March 17, 2020. Once adopted, the new bill made it possible to implement three of the eight activities targeted by the bill; these activities allowed pharmacists to act as frontline players at the heart of the pandemic and thereby participate in improving healthcare services. The other activities defined in Bill 31, among others, the right to adjust or renew prescriptions of all prescribers, are subject to monitoring by other professional bodies involved and will soon be implemented in turn.

Drugs in development

New drugs are at the development stage and being reviewed by Health Canada; mainly anticancer drugs, but also vaccines, biosimilar drugs and antidepressants. For example, SPRAVATO, a nasal spray for the treatment of severe and refractory depression, whose action begins in a few hours instead of a few weeks. LUXTURNA is a gene therapy indicated for visual loss due to hereditary retinal dystrophy. Hereditary retinal dystrophy has an estimated cost of close to $1 million when both eyes are affected. It goes without saying that all stakeholders are discussing potential solutions to expand access to these innovations to patients who need them.

Learn more about these issues and about other innovations in the pharmaceutical market by watching the complete video below. Available only in French.

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