- Private Drug Plans Waste Up to $5 Billion in Drug Spend Each Year
- Member Behaviour Changes Required to Reduce Waste
- Innovative Solutions Required to Encourage Optimal Member Behaviour
MISSISSAUGA, ON, May 23, 2012 /CNW/ - Express Scripts Canada, one of the largest providers of health benefits management services in Canada, today announced the findings of the Express Scripts Canada 2011 Drug Trend Report, an annual report produced by Express Scripts Canada that provides one of the country's most comprehensive analyses into the use of prescription drugs and related trends in the private sector throughout Canada.
Among the primary findings of the report is that while drug spend remained flat in 2011, private drug plans in Canada wasted approximately $5 billion in drug spend for the calendar year ended December 31, 2011. The newly released Express Scripts Canada 2011 Drug Trend Report defines waste as "spending that does not result in improvements to health outcomes". The report will be presented to interested parties via Webinars later this morning in French and this afternoon in English.
"Effective health care begins with clinicians who diagnose patients and design treatment plans to deliver the best health outcomes," said Michael Biskey, President of Express Scripts Canada. Plan sponsors - the organizations that provide drug plans to their employees - need to engage members and help them change their behaviour to effectively control and, where possible, eliminate all forms of waste.
"The key to reducing waste is to actively engage plan members and help make it easy for them to consistently choose a lower-cost, clinically effective medication from a lower-cost delivery channel while encouraging and facilitating adherence to their medication therapy. Optimal outcomes for the patient and the plan sponsor are only possible by changing the behaviour of patients."
Dealing with Waste at Multiple Levels
The Express Scripts Canada 2011 Drug Trend Report further categorizes waste as follows:
- Channel Waste. Waste in drug spend that is created by using suboptimal dispensing intervals for maintenance drugs, and by not using the most cost-effective distribution channels, totaled up to $1.1 billion in 2011.
- Drug Mix Waste. Waste in drug spend that occurs by using higher-cost medications that generate no additional health benefits, drug-mix waste in 2011 was up to $4.2 billion
- Non-Adherence Waste. Waste in overall health-care spend that is created when the patient does not take medications as prescribed, which leads to a worsening of condition that requires additional health-care spending, such as more physician visits, extra laboratory tests, additional drug therapy, emergency-room visits, hospital admissions, and short-term disability insurance payments. The total cost of non-adherence in Canada to the health-care system is estimated at $7 billion-$9 billion per year.
Other Key Findings
The Express Scripts Canada 2011 Drug Trend Report also quantifies changes in drug trend on a year-to-year basis, using de-identified claims data from millions of patients across Canada. More specifically:
- Drug Spend. On a national basis, the average annual drug spend per claimant in 2011 was $761, compared with $757 in 2010. The flat trend for the calendar year ended December 31, 2011 is a reflection of the increases in utilization, which have been offset by the decreases in cost per prescription (script).
- Utilization. Utilization continues to rise by about 2.5% every year, bringing the average number of prescriptions per claimant in 2011 to 12.6. By comparison, the average number of prescriptions per claimant was 12.3 in 2010. The continued upward trend is being driven by increased intensity (number of prescriptions per patient) and increased prevalence of medical conditions in part due to an aging Canadian population.
- Cost Per Prescription. The cost per prescription decreased 1.8% to $60.45 in 2011, compared with $61.55 a year earlier. The decrease was driven primarily by generic price reforms, as well as increased use of lower-cost generics due to several key patent expirations of brand-name medications. This decrease was however partly offset by increasing use of higher cost specialty medications. Taking a closer look at the cost per prescription:
- Dispensing Fee. Increases to dispensing fees across Canada continued to put upward pressure on the average cost per prescription. Overall, the average dispensing fee submitted in Canada increased to $10.74 in 2011, compared with $10.64 in 2010.
- Generic Drug Costs. Provincial generic drug-pricing reforms over the past two years have led to decreasing generic prices. Generic prices reduced during 2011 from approximately 60% of brand price to anywhere between 30%-45% depending on the region. However, this change was limited to formulary generics (approximately 15% of the total overall spend). In addition, these declines were partly offset by increases on non-formulary generics as well as price exemptions for some formulary items.
- Brand Drug Costs. Increases to the average price per brand prescription put upward pressure on spend in 2011. The primary driver was the increasing use of high-cost specialty drugs. Express Scripts Canada defines a specialty drug as "an injectable or non-injectable drug that is typically used to treat chronic, complex conditions". Although specialty drugs comprised just 1% of all drug claims, they contributed to almost 20% of the total spend. In addition, specialty drug spend increased by 12% in 2011, compared with traditional drugs which had a negative trend of 1.9% largely due to generic price reforms, as well as patent expiries.
- Brand/Generic Mix. Generic fill rate (GFR) continues to be a key metric for gauging the efficiency with which drug plans are taking advantage of a lower-cost, clinically equivalent medication. The GFR in Canada reached an all-time high of 50.8% in 2011, thanks to patent expiries of several highly utilized drugs. The first-time generic availability of brand drugs, such as Avapro and Zomig, also contributed to an overall 2.1% increase in the GFR in 2011.
Team Effort Required to Reduce Waste
To eliminate waste from the pharmacy benefit, plan sponsors need to drive significant member behaviour changes. Express Scripts research shows that while plan members have good intentions, their actual behaviour creates waste within drug plans. Private plans must engage members to unlock their good intentions and, where necessary, encourage and help them to change their behaviour.
Patients have a tremendous opportunity to help reduce waste while maintaining and possibly improving their health outcomes. Express Scripts Canada believes that this can be accomplished by engaging in three simple pharmacy-related behaviours:
- Use the more cost-effective delivery channels. For maintenance prescription medications, that means using a higher number of days of supply, where clinically appropriate, and securing the medication through the more cost-effective delivery channel.
- Use the lower-cost, clinically effective medications. Patients should not pay higher prices for medications that generate no additional health benefit. Private payers need to drive behaviour change to ensure patients optimize the use of lower-cost, clinically effective medications through the use of generic substitution and therapeutic substitution.
- Take medications as prescribed. Adherence to therapy is an extremely important behaviour: get a prescription filled, take it as directed, and renew/refill as required. Patients need to understand and eliminate the barriers between themselves and adherence to the treatment regimen they have been prescribed.
Innovative solutions are required to create behaviour change to achieve optimal behaviour. Efforts to drive out behaviour-related overspending can be significantly enhanced by applying the insights and proven strategies of behavioural sciences.
Better Care, Zero Waste Go Hand-in-Hand
Over the past few years, Express Scripts research has repeatedly demonstrated that better care and zero waste often go hand-in-hand - the most effective care can often costs the least. Thus the challenge is not simply to make these two goals compatible, but rather to do so in a manner that is acceptable to both members and plan sponsors. Surprisingly, the biggest gap is not between what plan sponsors want and what patients want, but rather between what patients want and what patients actually do.
This insight is crucial. As patients do not act on their existing good intentions, increased education and adjustments to financial incentives are of limited effect - a disappointing result consistent with the experience of many plan sponsors. Even more important, such a gap illustrates that many patients want exactly what plan sponsors want. In this case, the issue is not as much about convincing patients to align their behaviours with the interests of the plan sponsors, but rather helping them act upon their own underlying intentions.
Solutions that Drive Better Behaviour
To activate good intentions, Express Scripts, Express Scripts Canada's parent organization, leads the way in the convergence of the behavioural sciences and health care - an approach it calls Consumerology®. This unique approach provides plan sponsors with practical solutions that deliver better health and lower costs while preserving individual choice.
Express Scripts Canada knows that while people have good intentions, they are wired for inattention and inertia - people are creatures of habit. Therefore, traditional tools, such as education and financial incentives, will not close this gap between intent and behaviour because they focus on changing patients' minds rather than activating the good intentions that already exist.
The advanced application of the behavioural sciences to health care leverages proven strategies from the behavioural sciences to activate consumer intent. Express Scripts Canada's expanded pharmacy benefit management (PBM) service uses proven engagement and intervention tools that apply behavioural sciences to health-care decision-making to influence plan-member behaviour, and ultimately, the decisions that affect the prescription-drug benefit. As part of the service plan members, with the support of their physician, as appropriate, are proactively encouraged to interact with a team of highly qualified professionals to learn about their maintenance medication alternatives so that they can make more informed choices. The result aims at decisions that offer the best possible health outcome while reducing costs for both the plan member and the plan sponsor.
With Express Scripts Canada's expanded PBM service, Canadian plan sponsors finally have access to proven tools to better manage the cost of the prescription drug benefit while actually providing plan members with an enhanced prescription drug service.
Express Scripts Canada 2011 Drug Outcomes Report
Password-protected versions of the full Express Scripts Canada 2011 Drug Trend Report, in portable document format (PDF) in both English and French, will be posted later today to the Express Scripts Canada Website at www.express-scripts.ca/research/drug-trend-reports. Passwords can be requested by sending an EMAIL to Express Scripts Canada at ExpressScriptsCanadaOutcomesConferenceTOR@express-scripts.com.
2012 Pharmacy Outcomes Webinar
Later today, Express Scripts Canada will hold Webinars for customers, selected broker consultant partners and members of the media at which the findings of the Express Scripts Canada 2011 Drug Trend Report will be presented. The French-language Webinar will begin at 10 a.m. ET; the English-language Webinar will get under way at 1 p.m. ET. Interested parties may access the live Webinars from the Express Scripts Canada Web site at www.express-scripts.ca. Following the call, an audio archive and the replay-on-demand versions of the Webinars will be available on the Website at www.express-scripts.ca/research/drug-outcomes-conferences. To request a password for live or archived versions of these Webinars, send an EMAIL to ExpressScriptsCanadaOutcomesConferenceTOR@express-scripts.com.
About Express Scripts Canada
Express Scripts Canada, a registered business name of both ESI Canada and Express Scripts Canada Services, each an Ontario partnership, indirectly owned by Express Scripts, Inc., is one of Canada's leading providers of health benefits management services. From its corporate headquarters in Mississauga, Ontario, just outside Toronto, Express Scripts Canada provides a full range of integrated pharmacy benefit management (PBM) services to insurers, third-party administrators, plan sponsors and the public sector, including health-claims adjudication and processing services, Home Delivery Pharmacy Services, benefit-design consultation, drug-utilization review, formulary management, and medical and drug-data analysis services, to better facilitate the best possible health outcomes at the lowest possible cost. For more information about Express Scripts Canada, visit its Web site at www.express-scripts.ca.
About Express Scripts
Express Scripts manages more than a billion prescriptions each year for tens of millions of people. On behalf of our clients — employers, health plans, unions and government health programs — we make the use of prescription drugs safer and more affordable. We innovate to enhance patient care, reduce pharmacy-related waste and increase therapy adherence. Building on a strong clinical foundation, we apply our understanding of the behavioural sciences — an approach we call Consumerology® — to make it easier for people to choose better health.
Headquartered in St. Louis, Express Scripts provides integrated pharmacy benefit management services, including network-pharmacy claims processing, home delivery, specialty benefit management, benefit-design consultation, drug-utilization review, formulary management, and medical and drug data analysis services. The company also distributes a full range of biopharmaceutical products and provides extensive cost-management and patient-care services.
For more information, visit www.Express-Scripts.com
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