Data Trends and National Benchmarks; Perspective Overview. John Anacleto TELUS Health Drug Conference March 25, 2015

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1 Data Trends and National Benchmarks; Perspective Overview John Anacleto TELUS Health Drug Conference March 25, 2015

2 Agenda Summary message Cost trends Ranking lists Generics metrics Plan design statistics 6 What to watch for 2

3 Disclaimer The information provided is based on an analysis of prescription drug claims processed by TELUS Health for 12 million lives for many private insurers. This analysis considered past drug claims data only and it does not represent or imply future trends for drug plans or health plans, including drug coverage, for specific group benefit plans or specific insurers. In forecasting future trends it is important to also consider, for example: Changes in demographics Changes in utilization Government cost shifting 3

4 Terminology and definitions Cardholder: the covered employee and dependents. 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. Average age: the average cardholder age. Utilization: using the number of claims paid per cardholder. 4

5 1 Summary Message

6 Summary Costs growth rises again in 2014, relative to claims usage. Little change in the ranking of top diseases but a new drug entry has made the top 15 drugs sold. Utilization of mandatory generic substitution continues to increase, while cost share of generics decreases. Transferring costs to patients through co-insurance. 6

7 2 Cost Trends

8 Cost trends Total costs are impacted by two things: 1. Number of claims 2. Cost per claim So what s changing? 8

9 Claims, claimants and costs Costs continue to increase even though other measures slowed to 2013 Growth Rates for Ages 0 to 64 Claimants Claims Total Eligible Amount Cardholders Ontario -0.7% -1.1% 0.5% -0.5% Canada 1.5% 0.8% 1.3% 1.6% 2013 to 2014 Ontario 0.8% 1.9% 4.5% -1.7% Canada 2.4% 2.9% 5.6% 0.7% 9

10 Average eligible amount Pay direct drug card under 65 Costs are on the rise, again. Western Canada $713 ( 12) $681 ( 13) $690 ( 14) Ontario $1083 ( 12) $1078 ( 13) $1105 ( 14) Quebec $1046 ( 12) $1099 ( 13) $1133 ( 14) Canada: $948 ( 12) $935 ( 13) $950 ( 14) Atlantic Canada $1117 ( 12) $1063 ( 13) $1071 ( 14) 10

11 Key results by region 2013 and 2014 Pay direct drug card under 65 Canada Ontario Quebec Atlantic West Monthly eligible cost per cardholder Average cost eligible/rx Monthly Utilization $77.91 $79.15 $89.85 $92.11 $91.59 $94.42 $88.54 $89.28 $56.78 $57.48 $65.18 $66.93 $73.12 $75.12 $52.71 $54.27 $68.60 $70.82 $61.20 $

12 Eligible and submitted dispense fee Pay direct drug card under 65 Canada Ontario Quebec Western Atlantic Ave. Dispense Fee Eligible Amt Ave. Dispense Fee Submitted $9.96 $10.09 $9.68 $9.65 $11.22 $11.26 $9.19 $9.65 $9.94 $10.22 $10.87 $11.05 $11.11 $11.13 $11.33 $11.38 $10.07 $10.66 $10.64 $

13 Payers of prescription cost All drugs Pay direct card There has been a shift to Coordination of Benefits (COB) 13

14 Implication of changing demographics The drug spend is higher with age. As the bulk of claimants continue to age, potential cost spend will increase. 14

15 Key results by region 2013 and 2014 Pay direct drug card under 65 The average cardholder age did not change significantly. Canada Ontario Average Age

16 Distribution of claimants by age and costs The drug spend is higher with age. As the bulk of claimants continue to age, potential cost spend will increase. 16

17 3 Ranking Lists Identifying the top therapeutic areas and drugs focuses attention to where drug spend is highest, identifying opportunities for cost focus.

18 Top 11 drug classes by adjudicated amount All relationships Canada Therapeutic Class Rank (by Adjudicated Amount) Percent of Total Adjudicated Amount Rheumatoid Arthritis % 10.0% 9.0% Diabetes % 8.1% 7.7% Depression % 7.2% 7.3% Asthma % 5.7% 5.6% Blood Pressure % 5.1% 5.6% Ulcers % 4.7% 5.1% Antibiotics/Anti-infectives % 4.4% 4.7% Skin Disorders % 4.0% 3.8% Cholesterol Disorders % 4.6% 6.0% Narcotic Analgesics % 3.1% 3.1% Birth Control % 3.2% 3.2% Share Of Total Adjudicated Amount 59.0% 60.2% 61.1% 18

19 Top 15 drugs by brand name Brand Name Adjudicated Amt % Rank in Rank in Current Year Previous Year REMICADE 6% 1 1 HUMIRA 4% 2 2 INSULIN 3% 3 3 CIPRALEX 3% 4 4 ENBREL 2% 5 5 CYMBALTA 2% 6 6 SOVALDI 2% 7 NEW ADVAIR 2% 8 7 SYMBICORT 1% 9 8 CONCERTA 1% 10 9 STELARA 1% COVERSYL 1% NEXIUM 1% FLOVENT 1% VICTOZA 1% Total 31.4% New entry: 1. Sovaldi (new to market) 19

20 New drug Solvadi: SOVALDI (sofosbuvir) is indicated for the treatment of chronic hepatitis C virus (CHC) infection as a component of a combination antiviral treatment regimen. Received NOC on Average eligible treatment cost (including mark-ups) is $60,000 per year. Recommended treatment duration is between 12 to 24 weeks depending on genotype contracted by the patient. Once final treatment is complete, patient should not longer require further medication. 20

21 National therapeutic benchmark by frequency No change in the ranking by claim frequency. Therapeutic Class Rank (by # of claims) Percent of Total # of claims BLOOD PRESSURE % 9.2% 9.4% ANTIBIOTICS/ANTI-INFECTIVES % 8.5% 8.8% DEPRESSION % 7.8% 7.6% DIABETES % 6.2% 6.0% NARCOTIC ANALGESICS % 5.7% 5.6% ASTHMA % 5.5% 5.5% CHOLESTEROL DISORDERS % 5.5% 5.6% ULCERS % 4.8% 5.2% BIRTH CONTROL % 4.6% 4.8% SKIN DISORDERS % 4.4% 4.4% ANTI INFLAMMATORY/ANALGESICS % 3.4% 3.4% Share of Total # of claims 65.5% 65.7% 66.2% 21

22 4 Generic Metrics The entry and utilization of generic drugs provides some cost relief over time to private plans.

23 Key results by region 2013 and 2014 Pay direct drug card under 65 The utilization of generics drugs has increased. Canada Ontario Quebec Atlantic West % generics (# of Rx) 58% 60% 59% 61% 54 % 55% 62% 64% 60% 61% 23

24 Drug mix % of Rx 2013 & 2014 Ontario The proportion of claims for High Cost products has increased for biologic and non-biologic products. Canada Ontario Brand (Multi-Source) 9% 9% 8% 7% Generic 56% 58% 57% 59% Single Source (SS) 34% 33% 35% 34% SS High Cost: Biologic 1.1% 1.2% 1.1% 1.3% SS High Cost: Non Biologic 0.4% 0.5% 0.5% 0.6% SS Non-High Cost: Biologic 5.4% 5.8% 5.8% 6.1% SS Non-High Cost: Non Biologic 93.0% 92.5% 92.6% 92.1% 24

25 Drug mix % of adjudicated amount 2013 & 2014 Ontario The proportion of adjudicated amount also increases for high cost drugs. Canada Ontario Brand (Multi-Source) 8.3% 7.0% 7.4% 6.0% Generic 26.3% 25.9% 24.4% 24.3% Single Source (SS) 65.4% 67.1% 68.2% 69.8% SS High Cost: Biologic 22.5% 23.1% 22.6% 23.4% SS High Cost: Non Biologic 7.1% 10.2% 7.8% 10.8% SS Non-High Cost: Biologic 9.5% 9.0% 10.0% 9.2% SS Non-High Cost: Non Biologic 60.9% 57.7% 59.6% 56.6% 25

26 Generic substitution The proportion of cardholders with mandatory generic substitution continued to increase but from regular substitution, not plans without substitution. 26

27 5 Plan Design Statistics Metrics on plan design provide insight into benchmarking.

28 Co-insurance Ontario less cardholders with a co-insurance 20% is the most common. 28

29 Deductibles per year Per year deductibles are less common in todays market. 29

30 Deductibles per script Per script deductibles are also not very common. 30

31 Plan maximum statistics Approximately a quarter of cardholders have a plan maximum. 31

32 6 What to Watch For

33 What to watch for New products in the pipeline: cost versus utilization Changes in plan design: savings on cost by transferring them to patients through co-payments and maximums Future cost savings from more generics and SEBs 33

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