Diabetes, depression, attention deficit hyperactivity disorder (ADHD) and cystic fibrosis are among the conditions driving the utilization of private drug plans in recent years. On the near horizon, weight management and women’s health are poised to make bigger impacts.
“Diabetes maintains its number-one spot, which it took over in 2022,” said Vicky Lee, Manager, Pharmacy Consulting, TELUS Health, and presenter of Drug data trends and healthcare transformations during day one of TELUS Health’s 2024 annual conference on April 23. “Cystic fibrosis came into the top 10 for the first time, at number nine, bumping the gastrointestinal class out of the top 10.”
This year, for its 20th annual conference, TELUS Health broadened its retrospective analysis of drug data, going back 15 or more years rather than the usual five years, to give more of a macro view of changes in drug development and utilization. Combine that with an analysis of current emerging trends, and private drug plans clearly play a pivotal part in the delivery of “healthcare transformations,” noted Lee.
Looking back at 2008, only two of the top five therapeutic classes—depression and diabetes—remained in the top five in 2023. The remaining three classes of drugs for cholesterol, ulcers and blood pressure—described as “blockbuster drugs” 15 years ago—have fallen to 16th, 13th and 10th positions, respectively, due largely to lower-priced generic options.
The depression category ranked third in 2008, and fifth in 2023. “Some key generic approvals in the 2016 to 2017 time frame dropped its eligible amount slightly, but that’s balanced with new entrants to the class,” observed Lee, who also noted a small surge in utilization of antidepressants during the pandemic.
Closer look at diabetes
Diabetes, ranked fourth in 2008, bumped inflammatory diseases off the top of the list in 2022. Its number-one status can be attributed to “increases in overall prevalence of diabetes, changes to the [clinical treatment] guideline that recommends first-line combination treatments for certain patient populations, and the entry of more efficacious therapy options,” said Lee. He added: “Contributing to this is the off-label use of the GLP1 class indicated for diabetes, which we have seen being used for weight management.”
The highest growth rates in eligible amounts come from claimants aged 40 and older who have type 2 diabetes. “They will have more progressive diabetes requiring more therapy, [including] costlier options to control their disease,” noted Lee.
Having said that, growth rates have also climbed in recent years in the 19-and-under age group, composed mainly of people with type 1 diabetes. “More developments in blood glucose measuring devices targeted for type 1 diabetes, like the flash glucose sensors and the continuous glucose monitors, are contributing to the increase in cost growth in this population,” said Lee.
Looking ahead, the pipeline for type 2 diabetes is robust. Private drug plans can expect to see claims for three additional novel therapies, possibly starting this year. “All are seeing great clinical results for both the management of type 2 diabetes and weight management,” said Lee.
With all that in mind, “the management of the diabetes class will continue to be of importance,” summarized Lee. “Potential programs to manage utilization for this class for approved health indications include step therapy and prior authorization programs.”
Fastest-growing drug spends
High-cost specialty drugs for small patient populations dominate the fastest-growing therapeutic classes over the past 15 years, namely for inflammatory diseases, skin disorders, multiple sclerosis and cancer. All are now in the top-10 list.
In the non-specialty space, ADHD deserves attention. Ranked 19th in 2008, it claimed fourth position in 2023. The number of claimants taking ADHD drugs had climbed slowly for more than a decade and then significantly increased during the pandemic. “Much of this increase in growth came from young adults aged 20 to 40 years. Increased awareness from social media and other platforms may have contributed to the higher rates of diagnosis for the young adult population,” noted Lee.
The fastest growth in drug spend in the last two to three years come from cystic fibrosis (CF) and weight management. Ranked 56th in 2008, CF drugs broke into the top-10 list in 2023, ranking ninth. Significant advances in therapy fuelled the growth, culminating with the launch of Trikafta in 2021.
Ranked 46th in 2008, weight-management drugs ranked 29th in 2023. The number of claimants climbed slowly from 2015 to 2020, with the launches of Saxenda and Contrave, then began to accelerate in 2020 as acceptance grew among prescribers.
“Weight loss drugs were not standardly covered on drug benefit plans [but] the landscape has been changing. The World Health Organization now recognizes obesity as a risk factor for many chronic conditions,” said Lee. “We’re seeing a change in societal perception and a shift in accessing these therapies…that are more effective and tolerable and indicated for a wider patient population than their predecessors.”
Coming weight-management drugs, starting with the highly anticipated Wegovy, are expected to trigger dramatic growth within private drug plans. Lee also noted that the average cost per claimant for these medications is more than double what it was for predecessor drugs.
Eyes on women’s health
Lee emphasized the coming impact of products for women’s health, a market “previously underrepresented and overlooked.”
Early product entries since 2020 have already spurred growth in the number of claimants and the cost per claimant. Improved treatment options for menopause and endometriosis, conditions that can significantly impact workplace productivity, will drive much of the growth.
“We will also see advancements in options for contraceptives…and treatments [for conditions] where there were previously no or limited options,” said Lee, for example for female sexual desire disorder and postpartum depression.
On the other side of the equation, private plans can expect public-payor offsets in contraceptives. In fact, a slight decline in the number of claimants for women’s health products already occurred in 2022, likely due to the introduction of universal coverage for contraceptives in B.C. Manitoba announced universal coverage in 2023, and contraceptives are also included in the federal pharmacare program.
Profile of plan members
Lee closed her presentation with a snapshot of overall drug utilization trends in 2023:
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The average annual eligible amount per certificate (i.e., the employee and all linked beneficiaries) was $1,262, with significant regional variations.
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Certificates made an average of 15.1 claims, again with regional variations.
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The average eligible amount per claim was $83.53, varying by region.
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Generic drugs accounted for 68% of the prescription volume and 26% of the eligible amount.
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Specialty drugs accounted for 31% of the eligible amount, for 1.8% of claimants.
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The average cost per claimant increases with age and steadily increased across all age bands for the last 15 years; however, 2022 and 2023 recorded a “steeper upward trend…in the older age bands, in particular in the 50-to-54 age band,” noted Lee.
For full details and analysis, please see the presentation:
