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Use of ‘catastrophic’ drug plan surges in Ontario, study says

There are almost 130,000 Ontario residents who have “catastrophic” drug expenses and need government assistance to cover their costly medications, a new study shows.

The research, published in the medical journal CMAJ Open, shows that both the numbers of users and the overall cost of the Trillium Drug Program are soaring.

(To be eligible for the program, residents must have “catastrophic” drug costs – meaning they spend more than 3 per cent to 4 per cent of annual after-tax household income on prescription drugs – and be under the age of 65.)

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Use of ‘catastrophic’ drug plan surges in Ontario, study says.

JENS MORTENSEN/The New York Times News Service

Dr. Mina Tadrous, a research associate with the Ontario Drug Policy Research Network, said the data underscores the increasing financial pressures Canadians face in paying for prescription drugs.

“Catastrophic drug programs are the last line of defense for helping protect citizens from drug expenses that threaten their family’s financial security,” he said.

Researchers examined claims to the Trillium Drug Program between 2000 and 2016. (While the new research looks exclusively at Ontario, most provinces have some variation on a catastrophic drug program and the patterns of use and cost are likely similar.)

They found that, during this period, the number of claimants rose threefold to 128,166 from 37,436. The people making claims are increasingly younger (under 35) and not hospitalized, according to the research. (In Canada, drugs dispensed in hospitals are covered by medicare but drugs taken outside the hospital – even if they are identical – are generally not covered.)

Meanwhile, total annual expenditures for the Ontario program soared to $487-million from $51-million in that same time period.

Dr. Tadrous, who is also a fellow at the Institute for Clinical Evaluative Sciences, said the increases are being driven largely by the growing number of high-cost drugs, particularly biologics.

In 2000, only 3 per cent of claimants had drug costs greater than $1,000 and 1.6 per cent were dispensed high-cost biologics.

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In 2015, 10.4 per cent of claimants had drug costs over $1,000 and 5.5 per cent of them were taking high-cost biologics.

The most commonly used drugs by claimants are cholesterol-lowering statins (rosuvastatin and atorvastatin in particular), antibiotics such as amoxicillin and diabetes drugs such as metformin.

But the most costly drugs for the Trillium Drug Program are biologics used to treat people with rheumatoid arthritis and Crohn’s disease, such as infliximab (brand name Remicade) and the hepatitis C drugs ledipasvir/sofosbuvir (brand name Harvoni.)

The research paper notes that, in 2005, there were 20 drugs on the Canadian market that cost more than $10,000 annually; by 2015, that number had risen to 124.

But drug costs are not the only factor, the researchers note.

In Canada, drug insurance is provided principally by employers as part of benefits packages for employees, but an increasing number of people are self-employed or have precarious work.

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The study notes that employers, facing increasing costs pressures, are also hiking deductibles and reducing the number of drugs covered and may be fobbing off employees who require costly drugs on public drug programs such as Trillium. However, the data collected did not allow researchers to determine the private insurance status or the actual household income of beneficiaries of the program.

In Ontario, 53 per cent of residents are privately insured, while 21 per cent are uninsured and the remaining 26 per cent depend on public drug programs.

“With a larger number of expensive drugs currently under development, continued pressure on public insurers to control costs, and changing insurance coverage for workers, we anticipate the use of catastrophic drug programs will continue to grow,” Dr. Tadrous said.

He noted that while there has been much public discussion recently on the need for a national pharmacare program to cover essential medications, there has been little attention paid to the rising cost of expensive drugs and the burden placed on Canadians.

(The complexity here is that while pharmacare would ensure all Canadians have drug coverage, it does not mean that all drugs would be covered, meaning that catastrophic drug programs such as Trillium would likely still be required.)

Total prescription drug spending in Canada is roughly $30-billion a year. About $12-billion of that total is spent in Ontario, with just over $5-billion coming from the public treasury and the Trillium Drug Program is just one element of public coverage.

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