Staying Ahead of the Curve to Deliver Better Health Benefits for Less

By: Jeff Boutilier, General Manager of Pharmacy and Chief Clinical Officer, Express Scripts Canada

In today’s complex and competitive marketplace, companies continue to evolve their benefits programs to attract and retain top talent. In addition to perks like flexible work hours and wellness programs, an effective prescription drug benefit program that provides better health outcomes for employees and results in affordable costs for employers is more important than ever.

It’s important that employers, partner with a pharmacy benefit management company that recognizes this and leverages technology, innovation and data analysis to create better futures and health outcomes for employees across Canada and delivers cost-effective benefit plans for employers.

With the launch of Express Scripts Canada’s 2020 Prescription Drug Trend Reports, companies are provided with comprehensive research on the use of prescription medications in the Canadian private sector. This year’s Report confirms that innovative solutions are the key to controlling that cost of prescription drug benefit plans for employers. Innovative solutions are required, especially at a time when we have entered an age of million-dollar-per-treatment drug launches. Innovations that deliver potentially breakthrough treatments with high prices require us to be equally innovative in how the prescription drug benefit is managed. This is emphasized by the fact that costly, speciality drugs make up 60% of the total drugs in development.

“Better health is only possible when medications are accessible and prescription drug plans are affordable,” said Express Scripts Canada president, Dr. Dorian Lo.

The Report reveals that additional benefits have been found for drugs in therapy classes like diabetes and more costly options in diabetic supplies which can drive costs higher. While one in three Canadians are currently living with either diabetes or pre-diabetes, and an estimated one million are living with undiagnosed type 2 diabetes, this is a category to watch closely with employees in the coming years. Especially since these numbers are increasing rapidly, with more than 480 people in Canada diagnosed with type 2 diabetes every single day.

Further, cancer treatment remains a primary pharmaceutical research focus. In addition, there are more than 30 new rare disease treatments on the drug pipeline horizon. Also, within the Top 10 therapeutic classes we saw that inflammatory conditions continues to represent the largest portion of overall employee drug spend and is ranked number one for the 19- to 35-year-old age group. The total impact of these developments will be considerable and is something employers need to be mindful of as they will impact benefits costs in the coming years.

“While the majority of these specialty drug costs are concentrated on a relatively small number of claimants, the continued increase in use signals the need for innovative solutions to combat this trend,” said Dr. Lo.

When it comes to keeping employees healthy, those who manage multiple conditions and take multiple medications face unique challenges. These individuals have annual drug costs that are 16.2 times higher than the average employee. They also struggle with taking their medications as prescribed, which is known as medication nonadherence. This is a million-dollar issue for employers and can result in worsening health status, increased incidences of short-term leave, more hospital visits and avoidable health care expenses.

Nonadherence often affects the most prevalent chronic medical conditions, including high blood pressure, diabetes and depression. Since medications don’t work if they aren’t taken correctly, ensuring employees are taking their medications as prescribed in the early stages of their condition can help prevent it from progressing.

For example, medication adherence for conditions such as high cholesterol and high blood pressure helps prevent long-term complications for employees, such as heart attacks and strokes. This is significant as the data shows that 33% of members are nonadherent to these commonly prescribed medications.

Our data shows that 58% of plan members using two to three medications are nonadherent to at least one medication, and 77% of plan members are using more than four medications.

Medication nonadherence is an area where innovative solutions are required, and Express Scripts Canada had made this serious health issue a priority. There are currently two solutions that address nonadherence.

The first is the Medication Nonadherence Identification Report, which identifies the most problematic medical conditions within the group and allows for targeted programs to benefit its members. The second is the Predictive Medication Adherence Report, which predicts who is at risk for nonadherence and identifies specific interventions to be implemented before the condition becomes detrimental to an employee’s health. This proprietary predictive modelling focuses on the most prevalent conditions affecting our plan members: diabetes, high blood pressure and high cholesterol.

Both solutions show Express Scripts Canada’s commitment to addressing adherence and the cost savings for employers and associated health benefits for employees.

Another area of concern is the opioid crisis – a national emergency. Between January 2016 and June 2019, more than 14,000 Canadians died from opioid-related overdoses. In fact, in 2018 British Columbia reported a decrease in life expectancy, due in part to the opioid crisis.

A cause for concern is that many opioid users aren’t aware of the risks that come with taking opioids. For example, 1 in 5 Canadians suffer from moderate to severe chronic pain and might take opioids to help ease pain (for a back injury, for instance). But in these cases, the medication is intended for short term use only.

Express Scripts Canada is leading the way to safer opioid use through its Opioid Management Solution, which minimizes opioid exposure and prevents progression to misuse by limiting the “first fill” to a seven-day supply. This ensures a safe start of short-acting opioids. Early observations indicate, on average, an approximately 32% reduction in the average days’ supply per claim for first-time short-acting opioids, resulting in improved patient care and lower risks.

As we look ahead, we can see that benefit plan sustainability is threatened by rising costs, especially in areas such as diabetes and specialty medications. These costs can be lowered when HR professionals work with their benefits providers to improve employee health, such as medication adherence solutions, while introducing the right solutions to help manage costs.

The 2019 trend was driven by specialty (33%) and traditional (67%) spend; with an increase in specialty spending over 2018 by 32%.

As the General Manager Pharmacy and Chief Clinical Officer with Express Scripts Canada, Jeff Boutilier is responsible for the management and direction of pharmacy across Canada. He provides leadership and direction for the strategic, ethical, operational, clinical, financial and administrative functions associated with all pharmacy services.

All images are “courtesy of Express Scripts Canada”