2019 Retrospective Shawn O'Brien - TELUS Health...Microsoft PowerPoint - 2019 Retrospective Shawn O'Brien.pptx Author: T950881 Created Date: 5/27/2020 4:34:43 PM

#HealthBenefitsTrends

Data Trends and National Benchmarks Retrospective 2019

Shawn O’Brien

Principal – TELUS Health

2

I. Terminology and background

II. Key results

III. Drug type utilization

IV. Specialty drug analysis

V. Therapeutic category rankings

VI. Plan design trends

Content outline

3

Terminologyand definitions

4TELUS Proprietary#HealthBenefitsTrends

• Insured: any covered dual i.e. employee, spouse or child

• Certificate: the employee and the linked dependants

• Average age: average age of the insureds

• Utilization: number of claims paid per certificate or insured depending on the context

• Eligible cost: the cost of the drug considered eligible by TELUS Health. This measure does not take into account any cost sharing (deductible, co-insurance)

Terminology and background


Comparison with a specific group

• Results reflect the entire TELUS Health book of business (BoB)

• Results may differ significantly from plan to plan. The following elements have an important impact on the costs:

• Plan coverage

• Demographics:

• Age distribution

• Gender distribution

• Number of dependants

• Provincial distribution

• Industry



Comparison with a specific group (cont.)

For renewal, the factors used by carriers are based on many other elements:

• Group experience

• The entire medical claim not only drugs (including hospital, paramedical, out-of-country, etc.)

• Higher volatility for a specific group compared to TELUS Health BoB

• Ageing of insured population

• Changes in insurers manual rate

• Renewal is a prospective exercise, our analysis is retrospective



• Single-source brand –drug for which no generic exists

• Multi-source brand –one or more generics exist

• Generic –bioequivalent drug that is a copy of the innovator molecule



Except if otherwise mentioned, data in this presentation is based on:

• Insured aged less than 65

• Additional comparisons excluding OHIP+ ages (24 and younger) considering that OHIP+ was primary payer until April 2019

• Costs are eligible costs, i.e. before deductible and co-payment

• Regional comparisons are made where applicable




Ontario Outside Ontario Canada

2019 Trend 2019 Trend 2019 Trend

TELUS Book of Business –All ages

TELUS Book of Business – Change in number of certificates 2018-2019

2,118,000 1.5% 2,771,600 4.8% 4,889,500 3.4%

10

Key results


Key results by region – insureds age 25-64 l 2019

*

Canada West Ontario Quebec Atlantic

Eligible monthly cost per insured

Average eligible cost per claim

Monthly utilization per insured

% generic (# of Rx)

Average age of insured*

$54.01 $40.85 $55.91 $72.40 $67.09

$75.02 $70.35 $85.72 $61.22 $85.56

0.72 0.58 0.65 1.18 0.78

63% 66% 61% 63% 70%

44.0 43.3 44.4 44.3 45.3

* Age 0-64


Change in eligible monthly costs per insureds age 0-642018 to 2019

7.6 %

4.0 %

10.2 %

5.8 %

4.2 %

-2%

0%

2%

4%

6%

8%

10%

12%


2019 42.0 40.9 42.5 42.6 43.6

2018 42.1 40.9 42.8 42.4 43.9

Average age of Primary Certificate


Change in eligible costs per claim – insureds age 25-642018 to 2019

3.3%

2.5%

3.6%

4.5%5.0%

-1%

0%

1%

2%

3%

4%

5%

6%


2019 44.0 43.3 44.4 44.3 45.3

2018 44.1 43.3 44.5 44.4 45.3

Average age of Insured


Change in monthly utilization – insureds age 25-642018 to 2019

1.7%

1.0%

1.7%

0.3%

-0.3%

-1%

0%

1%

2%

3%



Change in eligible monthly costs – insureds age 25-642018 to 2019

5.1%

3.5%

5.4%

4.8% 4.7%

0%

2%

4%

6%

8%

7.6%4.2%

4.0%

5.8%

10.2%



Annual Trend Components – insureds age 25-642018 to 2019

5.1%Overall Trend

10.1%Specialty

Trend

2.9% Traditional

Trend


Annual Trend Components – insureds age 25-642018 to 2019

1.7% 1.2% 2.9%

UtilizationAverage Cost Per

Claim Annual Trend

7.8% 2.1% 10.1%

1.7% 3.3% 5.1%

Traditional Drugs

Specialty Drugs

Overall


Monthly eligible cost per insureds by age band 2019

$14.44$21.39

$34.14

$51.98

$74.74

$98.60

$0

$20

$40

$60

$80

$100

$120

<25 25-29 30-39 40-49 50-59 60-64

Canada


Monthly cost variation per insureds by age band2018 to 2019

27.9%

11.6%

4.9% 5.8% 5.0% 3.7%

-10%

-5%

0%

5%

10%

15%

20%

25%

30%

<25 25-29 30-39 40-49 50-59 60-64

Canada

20

Drug type utilization


Generic utilization l Per region – as % of Rx

57%

59% 59%60%

61%

64%

67% 67%69% 70%

50%

60%

70%

2015 2016 2017 2018 2019

Québec Ontario West Atlantic


Multi-source brand utilization l Per region – as % of Rx

14%

11%

9% 9%8%

6%5%

4% 4% 4%2%

4%

6%

8%

10%

12%

14%

2015 2016 2017 2018 2019

Québec West Ontario Atlantic


Utilization percentage by type of drug l #Rx

58% 60% 61% 62% 63%

33% 32% 32% 30% 29%

9% 8% 7% 7% 7%

0%

10%

20%

30%

40%

50%

60%

70%

2015 2016 2017 2018 2019

Generic Single-Source Brand Multi-Source Brand

Canada


Paid percentage by type of drug l eligible amount

Canada

26% 27% 26% 26% 25%

67% 67% 69% 69% 70%

8% 6% 5% 5% 5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

2015 2016 2017 2018 2019

Generic Single-Source Brand Multi-Source Brand

25

Specialty and biosimilar drugs


A TELUS Health specialty drug is a drug that has a high cost based on a potential per patient amount exceeding $10,000 per year

Further characteristics of these drugs may include but are not limited to:

• Requires special medication delivery (e.g. special handling, preparation, administration, storage, or distribution)

• Requires complex treatment maintenance (e.g. complex disease, complex dosing, intensive monitoring & clinical management etc.)

Specialty drug definition


Specialty drugs l less than 65

Canada

0.9% 0.9% 1% 1.1% 1.1% 0.7% 0.8% 0.9% 0.9% 1.0% 1.1% 1.1%

11%12%

14%15%

18%19%

22%

25%26%

27%29% 30%

0%

4%

8%

12%

16%

20%

24%

28%

32%

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

% of claimants % of total cost


Specialty drugs l less than 65

23%

31%

34%

38%

9%

11%

11%

12%

5% 10% 15% 20% 25% 30% 35% 40%

BC/SASK./MAN.

ONTARIO

QUÉBEC

ATLANTIC

2008 2019


Specialty drugs l less than 65 – monthly cost per certificate

Canada$78

$94

$0

$20

$40

$60

$80

$100

$120

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Total



Canada$70 $66$78

$94

$0

$20

$40

$60

$80

$100

$120

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Non Specialty Total



Canada

$9

$29

$70 $66

$78$94

$0

$20

$40

$60

$80

$100

$120

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Specialty Non Specialty Total



Canada

$9

$29$55

$70 $66$64

$0

$20

$40

$60

$80

$100

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

Specialty Non Specialty



Canada

$9$29

$55$70

$66$64$78

$94

$119

$0

$20

$40

$60

$80

$100

$120

$140

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

Specialty Non Specialty Total


Specialty vs traditional drug split l % of eligible amount

Canada

0.1%

10.6%

3.2%4.5% 5.1%

0.9%

3.9%

12.0%

3.7% 1.1%

3.2%

12.1%

10.6%

6.9%

5.6%5.1%

4.1% 3.9%

0%

2%

4%

6%

8%

10%

12%

14%

RHEUMATOIDARTHRITIS

DIABETES SKIN DISORDERS ASTHMA DEPRESSION CANCER ADD/NARCOLEPSY

Traditional Speciality


2.9%2.5%

3.3%

1.8%

0.0%

10.1%

6.3%

10.0%11.0%

12.7%

-2%

0%

2%

4%

6%

8%

10%

12%

14%Traditional Specialty

Change in eligible monthly costs – insureds age 25-642018 to 2019

Traditional vs

specialty



Adherence l Canada all ages 2019

23.0% 24.8%

65.8%

16.2%

4.7%

11.3%

5.7%

7.0%

0%

2%

4%

6%

8%

10%

12%

0%

10%

20%

30%

40%

50%

60%

70%

Depression Diabetes Asthma Cardiovascular andCholesterol

% Non Adherent

% Total Eligible

* Non-adherent is based on a patient with a Medication Possession Ratio of less than 0.8


Biosimilar New Starts - BC

13 2134

4660 62

80 90

120 129

188199

232

293 292

379

98115

133

177

227 230

261

297 293 300 302282

259 265 266247

SEP-18 OCT-18 NOV-18 DEC-18 JAN-19 FEB-19 MAR-19 APR-19 MAY-19 JUN-19 JUL-19 AUG-19 SEP-19 OCT-19 NOV-19 DEC-19

Number of new patients in British Columbia by month

BASAGLAR LANTUS



4

8 7

12

15 16

20

2830 31

2729

35

26

33

2 1

6

3

2224

17 17 16

13

18

14

21

16 15 16

1 13

5

2

6



INFLECTRA REMICADE RENFLEXIS


57 5661 61

71

7873

70

47

38 40 3834

39

32

38

2 4 37

10

18 16

23 24 2522

1620



COPAXONE GLATECT



Drug Shortages

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19

RANITIDINE FAMOTIDINE

l Canada 2019

41

Therapeutic category rankings


Top 10 drug classes by eligible amount

Therapeutic class Rank by total eligible amount Percent of total eligible amount

2019 2018 2019 2018

Rheumatoid Arthritis 1 1 12.1% 12.1%

Diabetes 2 2 10.6% 10.0%

Skin Disorders 3 3 6.9% 6.1%

Asthma 4 4 5.6% 5.6%

Depression 5 5 5.1% 5.1%

Cancer 6 6 4.1% 3.9%

ADHD / Narcolepsy 7 9 3.9% 3.4%

Multiple Sclerosis 8 8 3.6% 3.6%

Blood Pressure 9 7 3.3% 3.8%

Antibiotics / Anti-Infectives 10 10 2.9% 3.1%

% of total eligible amount 60.8% 58.8%


Top 10 products by eligible amount

Drug ProductRank by total eligible amount Percent of total eligible amount

2019 2018 2019 2018

Remicade 1 1 4.7% 4.7%

Humira 2 2 4.5% 4.5%

Stelara 3 4 2.0% 1.8%

Insulin 4 3 1.5% 1.8%

Vyvanse 5 8 1.3% 1.0%

Concerta 6 6 1.3% 1.2%

Freestyle Libre 7 40 1.0% 0.5%

Enbrel 8 5 1.0% 1.3%

Symbicort 9 9 1.0% 1.0%

Crestor 10 7 1.0% 1.1%

% of total eligible amount 19.3% 18.9%

44

Plan design


Generic substitution l # of insureds

Canada

20% 18% 16% 14% 13%

37%37% 35% 33% 31%

43% 45% 49% 53% 56%

0%

20%

40%

60%

80%

100%

2015 2016 2017 2018 2019

No generic Substitution Generic Substitution - Regular Generic Substitution - Mandatory

80% 87%


Generic substitution l # of insureds vs # of groups

Canada

2019

Insureds Groups

Generic substitution - mandatory 56% 86%

Generic substitution - regular 31% 8%

No generic substitution 13% 6%

87% 94%


Coinsurance l % of Certificates – Less than 65

Canada

32 %

13 %

43 %

12 %

31 %

13 %

46 %

10 %

0 %

5 %

10 %

15 %

20 %

25 %

30 %

35 %

40 %

45 %

50 %

100% 90% 80% Other%

2015 2019


Annual Maximums l % of Certificates – Less than 65

Canada

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

1 - 2,500 2,501 - 5,000 5,001 - 10,000 10,001 -25,000

25,001 -50,000

50,001 -100,000

100,001 -250,000

250,001 -500,000

2015 2019


Deductible l % of Certificates – Less than 65

Canada

10.0 % 10.0 %

14.0 % 13.0 %

76.0 % 77.0 %

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2015 2019

Annual Per Claim None0% 10% 20% 30% 40%

$0.01-1.99

$2-3.99

$4-5.99

$6-7.99

$8-9.99

$10+

Per Claim Deductible Amount

2019

2015


Dispense Fee Cap l % of Certificates – Less than 65

0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0%

< = 4.99

5 to 5.99

6 to 6.99

7 to 7.99

8 to 8.99

9 to 9.99

10 to 10.99

11 to 11.99

12 to 12.99

13 to 13.99

14 to 14.99

15 to 15.99

16.00 +

2019 2015

Canada


Formulary Type l % of Certificates – Less than 65

Canada

72 %

21 %

7 %

71 %

22 %

7 %

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

Open Managed Provincial

2015 2019


Prior Authorization l % of Certificates – Less than 65

Canada

93 %89 %

7 %11 %

0 %

20 %

40 %

60 %

80 %

100 %

2015 2019

PA No PA


Summary When focusing on the 25-64 age bands, the overall change in plan costs (based on monthly eligible

amount per insured) saw a 5.1% year over year increase across Canada. This increase was driven primarily by higher cost per claim with a lesser influence from increased utilization. However, on a region basis there are differences.

Plans that have a significant employee base in Ontario will see higher costs in 2019 and beyond, compared to 2018 given the repeal of OHIP+ in April 2019.

Specialty drugs now account for 30% of total eligible costs, but still resulting from just 1.1% of claimants. Specialty drug costs are trending much higher than traditional at 10.1% year over year.

We observed poor adherence across several chronic conditions. Although non-adherence can drive lower claim costs in that particular category, there is a risk of increasing costs downstream if the condition is not managed appropriately.

Chronic conditions and high cost treatments of more rare disease dominate the top drug class profile. Some of these categories, like RA and cancer, are propelled by high specialty drug costs in that category.

Continued slow but steady trend towards adoption of plan management features to contain costs. Additional levers to contain costs (PLAs, biosimilar strategies, high cost claimant and chronic disease management, etc.) will begin to emerge.

Questions

Thank you#HealthBenefitsTrends

Documents

2019 Retrospective Shawn O'Brien - TELUS Health...Microsoft PowerPoint - 2019 Retrospective Shawn O'Brien.pptx Author: T950881 Created Date: 5/27/2020 4:34:43 PM