Prescribed Drug Spending in Canada, 2013: A Focus on Public Drug Programs Chartbook May 2015

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The following slides are provided to reuse in your own presentations The following slides are provided to reuse in your own presentations. Please cite as follows: Canadian Institute for Health Information. Prescribed Drug Spending in Canada, 2013: A Focus on Public Drug Programs. Ottawa, ON: CIHI; 2015. Additional Resources The following companion products are available on CIHI’s website. Report Data tables Public summary Talk to Us For data-specific information: drugs@cihi.ca For media inquiries: media@cihi.ca www.cihi.ca

About CIHI’s NPDUIS Database and NHEX Data CIHI’s National Prescription Drug Utilization Information System (NPDUIS) Database provides data on key aspects of public drug plans in Canada. These include claims and formulary data, drug product information and plan information. Information from the NPDUIS Database is used to support accurate, timely and comparative analytical and reporting requirements for the establishment of sound pharmaceutical policies and the effective management of Canada’s public drug benefit programs. CIHI’s National Health Expenditure Database (NHEX) has been collecting, processing and analyzing summary data on all health spending in Canada since 1975. Health expenditures for the most recent 2 years are also forecasted. Information from NHEX is used to facilitate provincial/territorial, national and international comparative reporting. NHEX information also supports policy planning, decision-making and research. For more information, please contact Program Lead, National Prescription Drug Utilization Information System Database Canadian Institute for Health Information 495 Richmond Road, Suite 600 Ottawa, Ontario K2A 4H6 Phone: 613-241-7860 Fax: 613-241-8120 Email: drugs@cihi.ca Website: www.cihi.ca

In 2014, Canadians spent an estimated $28 In 2014, Canadians spent an estimated $28.8 billion on prescribed drugs Total Health Expenditure, by Use of Funds, Canada, 2014f Notes f: Forecast. $ billions; percentage share of total health expenditure. Source National Health Expenditure Database, 2014, Canadian Institute for Health Information.

Growth in prescribed drug spending has slowed in both the public and private sectors since 2000 Prescribed Drug Spending, Canada, 2000 to 2014f Notes f: Forecast. Rx Drug: Prescribed drug. Source National Health Expenditure Database, 2014, Canadian Institute for Health Information.

Recent years have seen slow growth in major health categories of public-sector health spending Annual Growth Rate of Publicly funded Health Spending, by Selected Categories, 2000 to 2014f Note f: Forecast. Source National Health Expenditure Database, 2014, Canadian Institute for Health Information.

In 2014, 42.0% of prescribed drug spending was financed by the public sector Publicly Funded Drug Spending as a Percentage of Prescribed Drug Spending, by Source of Finance, by Province and Canada, 2014f Notes * Social Security Funds include health care spending by workers’ compensation boards and the premium component of the Quebec Drug Insurance Fund. f: Forecast. Source National Health Expenditure Database, 2014, Canadian Institute for Health Information.

The top 10 drug classes accounted for 32 The top 10 drug classes accounted for 32.9% of public drug program spending Top 10 Drug Classes by Public Drug Program Spending, Selected Jurisdiction,* 2013 Drug Class Common Uses TPS ($ Millions) Proportion of TPS (%) Tumour Necrosis Factor Alpha Inhibitors (Anti-TNF Drugs) Rheumatoid Arthritis, Crohn’s Disease 576.7 7.4 Antineovascularization Agents† Age-Related Macular Degeneration 337.3 4.3 HMG-CoA Reductase Inhibitors (Statins) High Cholesterol 295.6 3.8 Proton Pump Inhibitors (PPIs) Gastroesophageal Reflux Disease, Peptic Ulcer Disease 249.6 3.2 Adrenergics in Combination With Corticosteroids or Other Drugs, Excluding Anticholinergics Asthma, Emphysema, Chronic Bronchitis 217.3 2.8 Angiotensin-Converting Enzyme (ACE) Inhibitors, Plain Heart Failure, High Blood Pressure 190.7 2.5 Selective Serotonin Reuptake Inhibitors Depression 185.8 2.4 Natural Opium Alkaloids Management of Moderate to Severe Pain 180.5 2.3 Other Antidepressants 171.5 2.2 Diazepines, Oxazepines, Thiazepines and Oxepines Schizophrenia, Bipolar Disorder 155.9 2.0 Combined Top 10   2,560.9 32.9 © Canadian Institute for Health Information, 2015 Notes * The 10 jurisdictions submitting claims data to the NPDUIS Database as of January 2015 are Newfoundland and Labrador, Prince Edward Island, Nova Scotia, New Brunswick, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia and the First Nations and Inuit Health Branch. † Spending on ranibizumab (which accounted for 99.9% of spending on antineovascularization agents) in Nova Scotia, Manitoba and British Columbia is funded through special programs and is not included in the NPDUIS Database. TPS: Total program spending. Source National Prescription Drug Utilization Information System Database, Canadian Institute for Health Information.

Generic drugs accounted for the majority of use but just more than one-third of spending Percentage Share of Public Drug Program Spending and Number of Accepted Claims (Brand Name and Generic), Selected Jurisdictions,* 2013 Note * The 10 jurisdictions submitting claims data to the NPDUIS Database as of January 2015 are Newfoundland and Labrador, Prince Edward Island, Nova Scotia, New Brunswick, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia and the First Nations and Inuit Health Branch. TPS: Total program spending. Source National Prescription Drug Utilization Information System Database, Canadian Institute for Health Information.

Percentage Change Over 2012 Decreased spending in some drug classes was largely offset by significant increases in others Average Annual Growth in Public Drug Program Spending for Top 10 Drug Classes by TPS, Selected Jurisdictions,* 2003 to 2013 Drug Class Common Use AAG in TPS, 2003 to 2008 (%) AAG in TPS, 2008 to 2013 (%) Percentage Change Over 2012 (%) Tumour Necrosis Factor Alpha Inhibitors (Anti-TNF Drugs) Rheumatoid Arthritis, Crohn’s Disease 39.0 24.8 18.3 Antineovascularization Agents† Age-Related Macular Degeneration 0.2 148.4 25.8 HMG-CoA Reductase Inhibitors (Statins) High Cholesterol 13.1 -17.3 -38.3 Proton Pump Inhibitors (PPIs) Gastroesophageal Reflux Disease, Peptic Ulcer Disease 3.7 -7.4 -25.4 Adrenergics in Combination With Corticosteroids or Other Drugs, Excluding Anticholinergics Asthma, Emphysema, Chronic Bronchitis 17.4 8.7 6.1 Angiotensin-Converting Enzyme (ACE) Inhibitors, Plain Heart Failure, High Blood Pressure -1.7 -7.6 -19.4 Selective Serotonin Reuptake Inhibitors Depression -1.2 -13.8 Natural Opium Alkaloids Management of Moderate to Severe Pain 13.3 3.4 0.7 Other Antidepressants 5.6 1.9 -10.2 Diazepines, Oxazepines, Thiazepines and Oxepines Schizophrenia, Bipolar Disorder 7.1 -7.9 -13.7 All Drug Classes   7.9 1.7 -2.4 © Canadian Institute for Health Information, 2015 Notes * The 5 jurisdictions submitting claims data to the NPDUIS Database as of January 2015 are Nova Scotia, New Brunswick, Manitoba, Saskatchewan and Alberta. Newfoundland and Labrador data is not available prior to 2009, Ontario and First Nations and Inuit Health Branch data is not available prior to 2011, and Prince Edward Island and British Columbia data is not available prior to 2005; these jurisdictions are thus excluded from the results. † Spending on ranibizumab (which accounted for 99.9% of spending on antineovascularization agents) in Nova Scotia, Manitoba and British Columbia is funded through special programs and is not included in the NPDUIS Database. AAG: Average annual growth. TPS: Total program spending. Source National Prescription Drug Utilization Information System Database, Canadian Institute for Health Information.

4 of 10 drug classes that contributed most to the growth of public drug spending are biologic agents Top 10 Drug Classes by Contribution to Public Drug Program Spending Growth, Average Annual Growth, Selected Jurisdictions,* 2008 to 2013 Drug Class Common Use Contribution to TPS Growth (%) Average Annual Growth (%) Percentage Change Over 2012 (%) Tumour Necrosis Factor Alpha Inhibitors (Anti-TNF Drugs) Rheumatoid Arthritis, Crohn’s Disease 126.3† 24.5 17.8 Antineovascularization Agents‡ Age-Related Macular Degeneration 33.3 148.5 25.7 Insulins and Analogues for Injection, Long-Acting Diabetes Mellitus 13.9 55.0 42.9 Adrenergics in Combination With Corticosteroids or Other Drugs, Excluding Anticholinergics Asthma, Emphysema, Chronic Bronchitis 13.3 8.5 5.2 Other Antipsychotics Schizophrenia, Bipolar Disorder 12.7 15.3 15.5 Protease Inhibitors Human Immunodeficiency Virus (HIV) 11.3 48.5 93.7 Drugs Used in Opioid Dependence Drug Addiction, Pain Control 9.5 12.5 6.5 Selective Immunosuppressants Organ Transplant 9.0 21.2 20.1 Interleukin Inhibitors Rheumatoid Arthritis, Psoriasis, Organ Transplant 8.1 106.8 63.1 Anticholinergics Emphysema, Chronic Bronchitis 6.8 8.6 6.2 All Drug Classes   100.0 1.5 -2.1 © Canadian Institute for Health Information, 2015 Notes * The 7 jurisdictions submitting claims data to the NPDUIS Database as of January 2015 are Prince Edward Island, Nova Scotia, New Brunswick, Manitoba, Saskatchewan, Alberta and British Columbia. Newfoundland and Labrador data is not available prior to 2009, and Ontario and First Nations and Inuit Health Branch data is not available prior to 2011; these jurisdictions are thus excluded from the results. † Contributing more than 100% to growth means that the dollar value of the growth in spending on the drug class was greater than the dollar value of the overall growth in spending. ‡ Spending on ranibizumab (which accounted for 99.9% of spending on antineovascularization agents) in Nova Scotia, Manitoba and British Columbia is funded through special programs and is not included in the NPDUIS Database. TPS: Total program spending. Source National Prescription Drug Utilization Information System Database, Canadian Institute for Health Information.

Proportion of Paid Beneficiaries (%) The majority of public drug spending was for a relatively small number of high-cost individuals Percentage of Paid Beneficiaries and Public Drug Program Spending, by Program Spending per Paid Beneficiary, 2013, Selected Jurisdictions* Program Spending Proportion of Paid Beneficiaries (%) Proportion of TPS (%) <$500 56.1 6.3 $500–$1,499 22.8 16.7 $1,500–$2,499 8.9 14.0 $2,500–$4,999 7.7 21.6 $5,000–$9,999 2.8 15.0 $10,000+ 1.6 26.3 © Canadian Institute for Health Information, 2015 Notes * The 10 jurisdictions submitting claims data to the NPDUIS Database as of January 2015 are Newfoundland and Labrador, Prince Edward Island, Nova Scotia, New Brunswick, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia and the First Nations and Inuit Health Branch. TPS: Total program spending. Source National Prescription Drug Utilization Information System Database, Canadian Institute for Health Information.

The share of public drug spending on high-cost chemicals more than doubled between 2008 and 2013 Proportion of Public Drug Program Spending and Proportion of Chemicals Paid, Chemical That Cost $10,000 or More per Paid Beneficiary, Selected Jurisdictions,* 2008 to 2013 Notes * The 7 jurisdictions submitting claims data to the NPDUIS Database as of January 2015 are Prince Edward Island, Nova Scotia, New Brunswick, Manitoba, Saskatchewan, Alberta and British Columbia. Newfoundland and Labrador data is not available prior to 2009, and Ontario and First Nations and Inuit Health Branch data is not available prior to 2011; these jurisdictions are thus excluded from the results. TPS: Total program spending. Source National Prescription Drug Utilization Information System Database, Canadian Institute for Health Information.