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Article highlights drug spending challenges, but overlooks solutions

Since 2011, Express Scripts Canada has reported on the urgency of unsustainable drug spending increases, and we were heartened to see this troubling situation underlined for Report on Business Magazine readers in Big Pharma versus Everyone. (Paul Christopher Webster, Nov. 1, 2016.) As the article points out, “Canadian drug expenditures almost doubled between 2000 and 2012.”

Even more alarming than the economic burden is the impact on health. For example, a study by the Canadian Diabetes Association found that 57 per cent of people with diabetes don’t take the medications their doctors prescribe – including medications required to prevent complications such as heart attack and stroke, blindness and kidney failure – because they couldn’t afford to. Calling this a national crisis understates the devastating future impact of this reality.

What Mr. Webster’s article overlooked, however, are the proven solutions that are available for implementation right now. The article correctly points to the Express Scripts Canada 2012 Drug Trend Report finding that uninformed patient decisions result in about $5-billion in spending waste by private drug plans. Our Drug Trend reports in 2013, 2014 and 2015 reconfirmed this finding: about one of every three dollars is wasted due to poor patient decisions related to their prescription drug benefit. (In our reports, “waste” refers to spending that does not improve health outcomes.)

Our drug claims analysis shows that, without help, patients take costly medications when more affordable alternatives are available; they do not take their medications as prescribed, which leads to worsening health and the need for more expensive treatments; and they pay more in prescription fees than is necessary.

By using behavioural science, clinical expertise and analysis of the drug claims we process each year for more than seven million Canadians, we’ve developed solutions that protect the sustainability of employer health benefits and help make funding available for life-saving but high-cost specialty drugs when they’re needed. One of these solutions is a new kind of pharmacy. By pivoting away from the traditional retail model, our pharmacists work directly with the patient, their doctor and their benefit plan – to help them make the best health decisions and get the most value from their plan, while lowering the costs for everyone. Our research also proves that when drug plan sponsors engage us to give members the information and support they need, in the right way and at the right time, spending waste declines and medication adherence rates improve.

Wider adoption of these solutions is critically important. Canada’s population is aging, and the latest Express Scripts Canada Drug Trend Report shows that more than half of drug claimants suffer from multiple chronic conditions. One in five has four or more chronic diseases at the same time. These patients often find their complex treatment plans unmanageable and experience gaps in care, and our analysis shows their health worsening over time.

This isn’t an inevitable progression. For instance, when one patient with multiple chronic diseases joined our pharmacy, with the patient’s consent, our pharmacists did a past claims analysis that revealed a possible duplication of medication that could cause weakness, drowsiness and confusion. By engaging the member and their doctors to discuss their full medication profile, the potential for dangerous side effects and complications was reduced. We also found the patient was not taking some of their preventative medications as directed, partly because of the difficulty of picking up their prescriptions. By optimizing the patient’s pharmacy and drug choices, communicating with them online and by phone, and delivering their medications to their home, we made it easy for the patient to stick with their treatment plan – while also making it possible for them to save money in prescription costs each year.

Needless to say, these benefits are exponential. With proactive, supportive treatment plans in place, financial and emotional stress is reduced. Time, money and energy are freed up to focus on maximizing health through better nutrition and physical activity. Complications don’t have to happen; conditions don’t have to get worse. Our results prove it is possible to make prescription drugs more effective and affordable for Canadians – but they can’t do it alone. With proactive, holistic care models, they don’t have to.

Michael Biskey,
Express Scripts Canada

Express Scripts Canada