The tipping point: how the rising price of new medications increases economic burden

Mina Tadrous is a research associate with the Ontario Drug Policy Research Network and assistant professor at U of T Pharmacy. He led a recent study published in CMAJ Open that found more people in Ontario are relying on the government’s catastrophic drug plan, called the Trillium Drug Plan, and that the province is seeing big increases in spending.

1. Describe your work.

In my work with the Ontario Drug Policy Network (ODPN) I work with policymakers to help them make informed decisions about drug policy. We use big data housed at the Institute of Clinical Evaluative Studies (ICES) to examine how a drug is being used; we can explore things like if it is safe and effective. Using data like drug claims and hospital records, we can explore the impact of medications on government spending and health outcomes. I also work as licenced pharmacist in the community.

2. What led you to study the catastrophic drug program?

Recently there has been a lot of discussion about the need for a national pharmacare program. Much of the debate is about what approach is best to implement a program like this; what do we need to consider? What do we need to prioritize?

In the pharmacy where I work, I’m seeing more people coming in with prescriptions for really expensive medications and it was these people who are getting pushed to the edge financially. Often these people access Ontario’s catastrophic drug coverage program, the Trillium Drug Program, which helps those with high drug-costs to reduce the burden of out-of-pocket expenses. In many ways, this really is the last line for people who require expensive medications. The program is for people under the age of 65 who spend about three to four per cent of their after-tax household income on prescription drugs.

I wanted to see how use of this program was changing so we set out to measure that along with spending and demographic profiles of people accessing the program.

3. How did you examine this issue?

We wanted to use data available to glean insight into the pressure these drug costs were putting on people – and to learn who was being affected. We used drug claims to see what was happening and examined data from Jan. 1, 2000, to Dec. 31, 2016.

Based on our experiences, we hypothesized that we would see a climb in use.

4. What surprised you most about your findings?

The biggest surprise was just how fast the spending was climbing. Total government spending rose by a staggering 840 per cent, reaching $487 million in 2016.

We were also surprised by the dramatic climb in the use and associated cost of biologic drugs. The highest single drug cost in 2000 was $2.6 million for atorvastatin (brand name Lipitor) used to lower cholesterol; in 2015 it was $55.4 million for infliximab (brand name Remicade) used to treat diseases such as Crohn’s disease and rheumatoid arthritis. Further, there was a large increase in the percentage of users with drug claims greater than $1,000 (3.4 per cent to 10.4 per cent).

5. What is your key message to policy makers?

The key message is we need to balance access to treatments with value of treatments. Meaning we need to know how well drugs work in the real world if we are going to pay for them – to make sure we get bang for our buck. We are starting to do a better job of this but there is a long way to go towards involving evidence and performance-based analysis in how we pay for drugs.

Second, as policy makers are exploring pharmacare they need to expand their view beyond essential medicines. New, expensive medications are putting a major burden on people. The reality is more innovative drugs are becoming available, which is positive, but it’s really hard for people to pay for them. This needs to be part of the conversation.