What you need to know about trends in medication use

The top three drug categories by eligible cost—for inflammatory disease, diabetes and skin disorders—saw strong growth in 2020. In fact, two posted double-digit growth rates, fuelled by newer, higher-cost products that may represent more effective treatment options for some patients.

These were among the findings presented by Vishal Ravikanti, Director, Operations, TELUS Health, during the Trends in Medication Management session of the 2021 TELUS Health’s annual conference. He also presented on the most costly medications, the biosimilar landscape, federal legislation updates (pharmacare and drug pricing reforms) and the drug pipeline (including gene therapy). 

Highlights include:

• The top three categories of drugs for inflammatory disease, diabetes and skin disorders accounted for 31.5% of eligible costs and 29.2% of claimants.
• The number-one category, for inflammatory disease, is dominated by biologic drugs and eligible costs grew by 6.6%. On the plus side for private plans, uptake of Inflectra, a lower-cost biosimilar option for Remicade (Canada’s top drug product by eligible costs), accelerated by 37.7%. The average annual cost per claimant for Inflectra is $14,689, less than half that of Remicade ($34,857).
• The number-two diabetes category grew by 10.9% in eligible costs. Two products drove this trajectory: Freestyle Libre, and next-generation blood sugar monitor that saw eligible costs increase by 44.7%; and Ozempic, a second-line therapy for type 2 diabetes that skyrocketed by 104.2% in 2020.
• The number-three category, for skin disorders, climbed by 13.1%, led by strong double-digit growth rates for several biologic drugs. Skyrizi, approved in April 2019 for psoriasis, soared by 1,201.4% in eligible costs.
• The top 10 most costly drugs, used by just 104 claimants in 2020, accounted for $47.3 million in eligible costs. All of them exceeded $280,000 in the average annual cost for claimant. “Five years ago, the top five most expensive drugs started at $250,000 per year. Today the top 10 start at $280,000,” remarked Ravikanti.
• Reference biologics that have biosimilar options saw declines in their share of claimants and eligible costs. B.C.’s mandatory biosimilar switching policy for its PharmaCare plan saw biosimilars’ share grow from 12% in early 2019 to 88% in the first quarter of 2021. Even in Ontario, which does not have a switching policy, biosimilars’ share grew from 4% to 14% during the same time period.

Ravikanti also commented on three evolving drug classes that are worth watching: PSCK9 inhibitors for cholesterol management, which account for 0.4% of claimants and 11.4% of eligible costs; CGRP inhibitors for migraine, representing 2.2% of claimants and 24.1% of costs; and oral cancer therapies, accounting for 2.7% of claimants and 8.0% of costs. “It’s likely that plan members are not achieving adequate control with existing or prior treatment options, so we are seeing a shift within these categories,” said Ravikanti. “Pockets of patients are trying newer, more costly treatment. A prior authorization process can support the use of these treatments for members who require them.”