Drugs that Increase Health Insurance Claims
High-Blood Pressure & Depression Contribute Most to Medication Costs
Mar 2, 2009
According to benefits consultant ESI Canada, Canadians spent a staggering C$22.5 billion on pharmaceutical drugs in 2007. By 2010, an aging population and the growth of specialty medications are factors expected to drive up overall drug spending by 25% to $28 billion. This amount would be even higher except for the increased use of generic drugs and the development of comparatively fewer blockbuster medications in recent years.
Highest Volume of Drug Claims by Treatment
ESI Canada’s detailed analysis identified the top 10 health conditions ranked by their respective percentages of total claims.
- High Blood Pressure … 12.8% of total claims
- Depression … 7.22%
- Antibiotics and anti-infectives … 7.19%
- Diabetes … 6.22%
- Pain and narcotic analgesics … 5.13%
- High cholesterol … 4.98%
- Asthma and chronic obstructive pulmonary disease (COPD) … 4.84%
- Ulcers and acid reflux … 4.39%
- Birth control … 3.83%
- Non-steroidal anti-inflation drugs (NSAIDs) for pain and inflammation … 3.76%.
In total, the above health conditions were responsible for some 60% of all Canadian drug claims in 2007.
Top Prescription Drugs by Annual Cost Per Claimant
The following list shows the 10 leading drugs with the highest annual charges for all Canadian provinces except Québec. In brackets are conditions that the drugs are typically prescribed to treat.
- Remicade (arthritis, ulcerative colitis) … $27,800 to $35,000 per patient
- Enbrel (arthritis, ankylosing spondylitis) … $20,000
- Advair (asthma, chronic obstructive pulmonary disease) … $960 to $1,635
- Nexium (gastrointestinal reflux, stomach ulcers) … $810
- Pantoloc (gastrointestinal reflux, stomach ulcers) … $755
- Lipitor (used to treat high cholesterol) … $640 to $860
- Crestor (high cholesterol) … $525 to $725
- Norvasc (high blood pressure) … $515 to $760
- Effexor XR and generics (depression, anxiety, panic disorders) … $220 to $880
- Altace (high blood pressure) … $190 to $245.
Remicade and Enbrel are the highest costing drugs, experiencing higher usage from older age groups. The brand name drug Lipitor is expected to come off patent in 2010, at which time generic high cholesterol drug versions are expected to lower that category of prescription drug costs.
New Blockbuster Drugs
2008 saw the introduction of the following new drugs and formulations, with prices sure to increase overall public and private spending on drug treatments. Targeted health conditions are shown within brackets.
- Elaprase (Hunter Syndrome) … $525,000 per patient
- Sprycel (leukemia) … $55,000
- Thelin (primary pulmonary hypertension) … $50,000
- Lucentis (age-related eye disease) … $9,450 to $19,000
- Atripla (HIV/AIDS) … $15,000
- Celsentri (HIV/AIDS) … $12,700
- Isentress (HIV/AIDS) … $10,400
- Cymbalta (depression) … $1,380 to $2,750
- Spriafil (fungal infections) … $2,780 per 14 days
- Ivega (schizophrenia) … $1,950
- Exelon Patch (Alzheimer’s dementia) … $1,650
- Eloxatin (colorectal cancer) … $1,500 per cycle
- Mezavant (ulcerative colitis) … $1,150 to $2,300
- Januvia (Type 2 diabetes) … $1,060.
High-Cost Drug Claimants
The top 1.5% of claimants spend more than $5,000 per year on drugs, and account for 23.7% of total Canadian drug claim costs in 2007. ESI Canada also noted that 38% had one or more of the following health conditions:
- Cardiovascular disease (high cholesterol, high blood pressure)
- Mental health issues (depression, attention deficit disorder)
- Diabetes.
Claimants in the 38% group typically use several medications on an ongoing basis, and therefore represented 76.2% of overall prescription drug spending.
ESI Canada concludes that effective claims cost control will focus on improving plan member wellness and provide disease management programs. These measures will both reduce overall drug spending and improve employee health.
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