COVID-19 makes its mark, repeatedly, on drug claims in 2020

Without a doubt, the COVID-19 pandemic had a whirlwind effect on claims patterns for private drug plans in 2020. Yet its net cost impact was, perhaps surprisingly, relatively minimal, attendees learned during day one of TELUS Health’s annual conference on April 20.

For example, while claims for maintenance medications for chronic conditions spiked during the early months of the pandemic due to Canadians’ efforts to stockpile as well as governments’ counterefforts to protect the drug supply, this was offset by a sharp, prolonged decline in claims for acute medications due to delayed surgeries and fewer visits to physicians’ offices.

As well, although claims for drugs to treat depression increased by more than 10% for insured adults and by more than 20% for their dependents, the drug category’s share of total costs did not change, likely due to the relatively low costs of first-line, generic medications.

Having said that, these results are but a snapshot of claims activity and the jump in claims for antidepressants cap a growth trend that will have much broader cost and productivity implications in the long term—particularly regarding the workforce of the future.

“It’s important to note that in the 20 to 39 age group, the number of claimants for antidepressants climbed from 5.6% in 2016 to 7.9% in 2020. Expressed as a ranking, antidepressants have gone from ranking seventh to ranking fourth,” said Shawn O’Brien, Director, Data Enablement and Drug/Health/Dental Product Roadmap, TELUS Health, who presented the Data Trends and National Benchmarks Retrospective 2020 report.

When all is said and done, the 3.8% growth rate for total eligible monthly costs for all insureds in 2020 over 2019 is not remarkably higher or lower than results for the previous four years. When insureds under the age of 25 are excluded to mitigate the impact of Ontario’s OHIP+ during the first quarter of 2019, that rate settles down to 3.6%.

Other highlights from the presentation include:

• The eligible monthly cost per claim for insureds aged 25 to 64 increased by 1.5% in 2020 compared to 2019. Monthly utilization increased by 2.1%.
• When utilization and cost per claim are combined, the change in annual trend for specialty drugs (8.7%) is more than six times the change for traditional drugs (1.3%).
• Specialty drugs’ share of eligible costs climbed by two points to reach 32% of total costs, for 1.3% of claimants. Private plans in Atlantic Canada are most impacted, with 40% of eligible costs attributable to specialty drugs.
• C.’s switching policy for biosimilar biologics benefited private plans: by the end of 2020, biosimilars’ share of biologic drug costs had more than quadrupled, to 69%, since the government’s policy was implemented in May 2019.
• The top five therapeutic areas based on eligible costs continue to be rheumatoid arthritis, diabetes, skin disorders, asthma and depression.
• The pandemic caused claims for anti-infectives to plummet enough for the category to drop off the top-10 list.
• Claims for maintenance medications spiked in March as Canadians stockpiled medications and again in May and June due to governments’ efforts to protect the drug supply by limiting quantities dispensed for refills (thereby increasing the number of claims).
• Claims for hydroxychloroquine, briefly considered as a possible treatment for COVID-19 until evidence proved otherwise, increased by 21% during the second quarter of 2020.
• 56% of certificates have plans that include mandatory generic substitution policies, unchanged from 2019. Generic drugs now account for 64% of prescriptions dispensed to private drug plan members, up from 60% five years ago.