Retrospective Data Trends and National Benchmarks. Vincent Ng Sr. Manager, Health Business Consulting

Transcription

1 Retrospective Data Trends and National Benchmarks Vincent Ng Sr. Manager, Health Business Consulting

2 Disclaimers The information provided is based on an analysis of prescription drug claims processed by TELUS Health who adjudicates for over 11 million lives with private insurance. The data used for the analysis was sourced from the TELUS Health Data Warehouse as of March 2017, reflective of the age group 0 to 64. Comparison with previous years' presentations may show minor differences in numbers due to data updates and methodology upgrades. Further details are available upon request. 2

3 Terminology and Definitions All Cardholders: the covered employee and dependents Primary Cardholder: the employee only without dependents, or certificate holder Claimant: the cardholder making a claim, i.e. patient Eligible costs: the cost of the drug found eligible by TELUS Health. This measure does not take account of the deductible or co-insurance. Adjudicated amount: amount paid by TELUS Health incorporating the private plan features TELUS BoB: TELUS Health Book of Business 3

4 Agenda Trends Specialty Drugs Rankings 4

5 Take Home Messages Costs continued to rise in 2016 The increasing number of claimants is a major contributor to cost growth Specialty Drugs continue to contribute to cost growth Hepatitis C costs and claimants stabilized in 2016 Generic substitution has contributed to cost savings, but more can be done 5

6 Agenda Trends Specialty Drugs Rankings 6

7 Average eligible cost per cardholder is rising Total Eligible Amount $Millions 3,671 3,937 4,140 = Number of Cardholders* Millions X Eligible Amount per Cardholder Dollars Percent Change Over Previous Year 5.9% 7.2% 5.1% 3.7% 3.0% -0.6% 2.1% 4.1% 5.8% * Population analyzed 7

8 The cost per claim and number of claimants rose in 2016 Eligible Amount per Cardholder Dollars Eligible Amount Claimants as Percent = X X per Claim of Cardholders Dollars % Percent Number of Claims per Claimant Percent Change Over Previous Year 2.1% 4.1% 5.8% 2.7% 3.6% 1.1% -1.0% 0.3% 3.6% 0.5% 0.2% 1.0% 8

9 Cost per cardholder growth rate varied across Canada Eligible Amount per Cardholder Dollars BoB Western Canada Ontario Quebec Atlantic Canada % 3.5% 6.0% 4.3% 17.5% 9

10 Cost per cardholder growth rate varied across Canada (Primary Cardholder view) Eligible Amount per Primary Cardholder Dollars BoB Western Canada Ontario Quebec Atlantic Canada 975 1,009 1, ,092 1,119 1,177 1,146 1,200 1,244 1,014 1,124 1, % 2.8% 5.2% 3.7% 17.5% 10

11 The average eligible amount per claim in Ontario was higher than the TELUS BoB Eligible Amount per Cardholder Dollars Eligible Amount Claimants as Percent = per Claim X of Cardholders X Dollars % Percent Number of Claims per Claimant BoB West ON QC Atlantic

12 and grew the fastest over 2015 Eligible Amount per Claim Dollars BoB Western Canada Ontario Quebec Atlantic Canada % (0.1)% 2.1% 0.1% 1.0% 12

13 The percent of cardholders that made a claim in 2016 rose across all regions % Percent Change over 2015 Eligible Amount per Cardholder Eligible Amount Claimants as Percent = per Claim X of Cardholders X Number of Claims per Claimant BoB West ON QC Atlantic

14 Ontario private plans covered 80% of eligible costs, compared to 78% across the TELUS BoB Eligible Amount per Claim $ Dollars Adjudicated Amount per Claim $ Dollars Adjudicated Amount as Percent of Eligible % Percent Percent Change in Adjudicated Amount over Previous Year BoB West ON QC Atlantic

15 The cohort accounted for a disproportionate share of costs in Ontario % Percent in Ontario by: 20.0 Claimants <20 Eligible Amount

16 but the youngest cohorts costs grew the fastest % Percent Change over 2015: Claimants 3.6 <20 Eligible Amount

17 Ontario private plans spent more on Brand Single-Source than the TELUS BoB Type of Drug by: Adjudicated Amount Number of Claims Ontario Generic Brand Multi-Source Brand Single-Source TELUS BoB

18 despite similar levels of generic utilization Cardholders with Generic Substitution % Percent of Total Ontario Mandatory Regular BoB

19 Low-Cost drugs account for the majority of Brand Single- Source costs and claim volume Brand Single-Source, TELUS Book of Business % Percent of all Brand Single-Source Low Cost High Cost (> $10,000 per year) Non-Biologics Biologics 19

20 but Specialty costs and claims are growing the fastest Brand Single-Source, TELUS Book of Business % Change Over Previous Year Low Cost High Cost Non-Biologics Biologics 20

21 Agenda Trends Specialty Drugs Rankings 21

22 TELUS definition of Specialty Drug A TELUS Health specialty drug is a drug that has a high cost based on a potential per patient amount exceeding $10,000 per year Further characteristics of these drugs may include but are not limited to: Requires special medication delivery (e.g. special handling, preparation, administration, storage, or distribution) Requires complex treatment maintenance (e.g. complex disease, complex dosing, intensive monitoring & clinical management etc.) 22

23 The number of non-biologic Specialty Drugs has grown an average of 15% per year since 2008 Number of Specialty Drugs in Canada Counts Non-Biologic Biologic

24 Specialty Drugs account for 26% of total costs, despite being used by less than 1% of all claimants % Percent of TELUS Book of Business by: Claimants Eligible Amount

25 across all regions in the TELUS Book of Business Specialty Drugs as % Percent of Eligible Amount BoB Western Canada Ontario Quebec Atlantic Canada

26 Specialty drives up eligible costs per claimant Average Eligible Amount per Specialty Drug Claimant Dollars X % Percent of Total Claimants Blended Eligible Amount per Claimant Dollars 18,246 18,915 18, Average Eligible Amount per Non-Specialty Drug Claimant Dollars X % Percent of Total Claimants

27 Agenda Trends Specialty Drugs Rankings 27

28 Top 10 Drug Classes by Adjudicated Amount Therapeutic Class Rank (by Adjudicated Amount) % Percent of Total Adjudicated Amount Immunomodulators (e.g. RA) % 11.0% Diabetes % 8.3% Depression % 6.0% Asthma % 5.5% Skin Disorders % 4.2% Blood Pressure % 4.5% Antibiotics/Anti-Infectives % 4.4% Ulcers % 4.1% Multiple Sclerosis % 3.1% ADD/Narcolepsy % 2.9% Share Of Total Adjudicated Amount 54.7% 54.0% 28

29 Top 15 Brand Single-Source by Adjudicated Amount Trade Name Disease Name % Percent of Avg. Eligible Cost/ % Percent Change in Adjudicated Amount Claimant Claimants over 2015 Remicade Rheumatoid Arthritis ,590 4 Humira Rheumatoid Arthritis , Enbrel Rheumatoid Arthritis ,020-3 Stelara Skin Disorders , Advair Asthma Symbicort Asthma Concerta ADD/Narcolepsy Coversyl Blood Pressure Harvoni Hepatitis , Vyvanse ADD/Narcolepsy Cymbalta Depression Xolair Asthma , Victoza Diabetes 1.1 1,875 4 Janumet Diabetes Abilify Mental Disorders Total 30.4 $1,

30 Hepatitis Treatment Costs started to stabilize in 2016 $14,000 Avg. Cost / Claim # of Distinct Claimants 1,000 $12, $10, $8, $6, $4, $2, $0 0 30

31 Cholesterol Treatment Costs were steady in 2016 $120 Avg. Cost / Claim # of Distinct Claimants 250,000 $ ,000 $80 150,000 $60 $40 100,000 $20 50,000 $0 0 31

32 Take Home Messages Costs continued to rise in 2016 The increasing number of claimants is a major contributor to cost growth Specialty Drugs continue to contribute to cost growth Hepatitis C costs and claimants stabilized in 2016 Generic substitution has contributed to cost savings, but more can be done 32

33 Questions

34 Thank You