Generics slow Canadian drug spending growth

Canadians spent a record amount on prescription drugs last year, but the annual rate of spending growth has slowed due to the greater availability of less-expensive generic drugs, a new report says.

People in Canada spent $29.3 billion on prescription drugs last year, the Canadian Institute for Health Information (CIHI) said in a report released Thursday.

But while spending on drugs continues to rise, it was at a slower rate of 2.3 per cent in 2013, one of the lowest in more than two decades, due to more patents expiring on major pharmaceuticals and related pricing policies.

• Generic drugs to be bought in bulk by provinces

Much of the institute's report focused on public drug programs, with data collected in the previous year, 2012.

The CIHI said several of the most commonly prescribed drugs are now available in generic form. Its report said generic products as a share of the total number of accepted claims accounted for 72.4 per cent in 2012.

About 24% of spending is out-of-pocket

The report noted that public-sector drug spending in Canada is forecast to have grown only negligibly, at a rate of less than 0.1 per cent, the lowest rate since 1996, when spending decreased.

Last year, 41.6 per cent of prescribed drug spending was financed by the public sector, with the remainder financed by private insurers (34.5 per cent) and out of pocket by households and individuals (23.9 per cent), the CIHI said.

The majority of public-sector spending is funded by provincial/territorial governments, and seniors account for a high proportion of public drug program spending, due to the design of these programs, the report said.

Treating autoimmune arthritis expensive

A class of drugs known as anti-TNFs (tumour necrosis factor alpha inhibitors), used to treat autoimmune conditions such as rheumatoid arthritis and Crohn's disease, accounted for the highest proportion of public drug program spending in 2012.

These were followed on the list by statins, used to lower cholesterol levels, and then drugs to treat peptic ulcers and acid reflux disease.

Statins rose to the number 1 spot in the same payment ranking for seniors alone, followed by drugs to treat age-related macular degeneration. In third spot were drugs to treat ulcers and acid reflux, followed in fourth place by those to counter heart failure and high blood pressure.

Seniors accounted for 61.5 per cent of provincial/territorial program spending on prescribed drugs in 2012, the report said.

Rounding out the seniors' list of 10 drug classes for public drug program spending:

• Adrenergics and other drugs to treat asthma, emphysema and chronic bronchitis.
• Dihydropyridine derivatives to treat high blood pressure.
• Anticholinesterases for Alzheimer's disease.
• Anti-NTFs for rheumatoid arthritis and Crohn's.
• Anticholinergics for emphysema and chronic bronchitis.
• SSRIs

For non-seniors, here are the top 10 drug classes ranked in order by public program spending:

• Anti-TNF drugs for rheumatoid arthritis and Crohn's.
• Natural opium akaloids for pain management.
• Diazepines, oxazepines, thiazepines and oxepines for schizophrenia and bipolar disease for schizophrenia and bipolar disorder.
• Other antipsychotics for schizophrenia and bipolar disorder.
• Other antidepressants (not SSRIs).
• SSRIs (selective serotonin reuptake inhibitors).
• Interferons for multiple sclerosis and chronic hepatitis C.
• Antivirals for HIV.
• Drugs used to treat opiod dependence.
• Statins for high cholesterol.

Between 2007 and 2012, anti-TNF drugs contributed to more than half (54.8 per cent) of the growth in drug program spending and were the top contributor to growth.

Looking at seniors and non-seniors together, the report found two of the top three drug classes that contributed most to the growth of public drug spending were anti-TNF drugs and antineovascularization agents. The latter is for treatment of age-related macular degeneration.

"The majority of public drug spending is for a small number of high-cost individuals," the institute said in a release.

More than 60 per cent of public drug money is used for 12 per cent of Canadians, each of whom has $2,500 worth of prescription drugs paid for by public programs, CIHI said, adding the information is based on data from eight provinces, excluding Quebec.