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

2. Our Vision Our Mandate Our Values
Better data. Better decisions. Healthier Canadians.
Our Mandate
To lead the development and maintenance of comprehensive and integrated health information that enables sound policy and effective health system management that improve health and health care.
Our Values
Respect, Integrity, Collaboration, Excellence, Innovation

3. 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:
For media inquiries:

4. 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 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:
Fax:
Website:

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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, to 2008 (%)
AAG in TPS, 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.

12. 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.

13. 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.

14. 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.