What the latest drug utilization trends can tell plan sponsors

Data from 2021 shows traces of 'shadow pandemic' risks and continued rise in costs

What the latest drug utilization trends can tell plan sponsors

In its recently released 2022 Drug Data Trends and National Benchmarks Report, Telus Health found that even a year after the initial impact of COVID, its effects still manifested in the utilization and claims activity of Canadians covered under employer health plans.

“The pandemic continued to have a noticeable impact on the use of, and need for, prescription medications and insurance claims throughout 2021,” says Shawn O’Brien, Principal, Data Enablement and HBM Product at Telus Health. “Medications for depression climbed to fourth position on the top-10 list in terms of utilization, largely due to ongoing mental health challenges intensified by the pandemic.”

According to O’Brien, 2021 saw therapeutic drug classes, including those used to manage attention deficit hyperactivity disorder (ADHD), rise to 6th out of the top 10 in utilization overall. And whereas five years ago, medications to treat neurodivergent-related disorders ranked 10th, medications like Vyvanse and Concerta surpassed cancer medications in the rankings last year.

“Homeschooling may have contributed to the increase of ADHD diagnosis of children who may have found it difficult to focus in front of a screen all day,” O’Brien says.

While antibiotics and anti-infectives continued to be the top category in terms of number of claimants, the share of claimants they represent dropped significantly both in 2020 and 2021. “Prescription medication trends were impacted by delayed diagnosis, surgeries and people accessing new medications related to conditions they developed during the pandemic,” he says.

As fewer people sought out treatment for more common ailments during the depths of the COVID crisis, they did not access their physician for antibiotic prescriptions. Lockdowns also translated into a lowered risk of community transfer in schools and workplaces, which led to a reduced need to treat infections.

Carrying on from previous years, specialty drugs had a bigger impact on overall utilization trends compared to traditional drugs. Last year, the average eligible amount for specialty medications saw growth rates of about 10%, making them a significant driver of overall costs in drug plans. The top three disease categories driven by specialty medications include rheumatoid arthritis, psoriasis, and cancer.

Over the last five years, O’Brien says the compound annual growth rate (CAGR) of percentage of claimants for specialty drugs was 8.8%, higher than the CAGR of 5.9% seen for specialty drug costs.

The latest utilization trends for drug plans, O’Brien says, add to concerns about a possible brewing “shadow pandemic” of illnesses. After countless Canadians were forced to put off or cancel appointments for in-person screenings, the healthcare system is now working through a backlog of cancer diagnostic tests. A similar situation is developing in cases where people were unable to access mental health services and treatments.

He also points to drug-supply policies put into effect during the early months of the pandemic in most provinces, which led to more refills on prescriptions for chronic conditions, as prescriptions were limited to a 30-days supply to guard against shortages and/or stockpiling.

“We will likely see delayed adverse effects from the pandemic on the health insurance industry, which is important for insurers and employers to remain aware of as they prepare for upcoming years,” O’Brien says.

Even though fewer insureds made claims last year, the eligible amount spread out across claimants rose. Data from the past two years show the growth rate for eligible amount per claim in drug plans was significantly above inflation, as measured by the CPI, which includes the record highs seen in the later months of 2021.

Looking ahead, O’Brien encourages plan sponsors to regularly monitor plan performance to get a bead on cost drivers and risks, which can guide decisions on where plan design may need to change, as well as where communications with plan members may need to be focused. The ability to review data on adoption of specific plan design solutions, he adds, may help guide sponsors on where changes need to be focused to help ensure the future sustainability of benefit programs.

O’Brien suggests a number of strategies for plan sponsors to consider, including:

  • Prior authorization and other measures to support adoption of biosimilars, which can help ensure patients receive the most cost-effective and appropriate therapy based on clinical need;
  • Mandatory generic substitution;
  • The potential use of virtual health care to improve adherence rates and support chronic disease management; and
  • Health spending accounts, wellness accounts and increased maximums on paramedical services.