Should I be celebrating? CIHI (the Canadian Institute for Health Information) released a report on spending on prescription drugs in Canada* (PDF) today. The summary page of the report is pretty clear:
- The majority of public drug spending is for a small number of high-cost individuals.
- More than 60% of public drug money is used for 12% of Canadians, each of whom has $2,500+ worth of prescription drugs paid for by public programs.
In fact, it’s even worse! Provincial drug programs spent an average of $17,782 per insured person on anti-TNFs biologics like Remicade in 2012 (page 15) (so my drug costs are above average even for someone on biologics). That’s bad enough, but the annual growth in expenditures on anti-TNFs from 2007 to 2012 was 28.1% (page 15), and, over the same period, this class of drugs was “the top contributor to growth in each jurisdiction for which data was available” (page 14).
In other words, for every $10,000 spent on anti-TNF agents in 2007, $12,810 was spent in 2012. Note that this was during the great recession, when growth in income was, at its best, in the low single digits (Statscan link).
So is it time to freak out about growing drug costs?
Well, yes and no. If we put all this in context, the same report says that, in 2012, anti-TNF drugs “accounted for the highest proportion of public drug program spending, at 6.5%” (page 11). For instance, here, in Ontario, total public spending on anti-TNF drugs in 2012 was just over $170 million, though this represented only 4% of total drug program spending (page 42). So, yes, we are talking about a lot of money, and high growth in the spending on anti-TNF biologics, it’s still only a small proportion of the entire drug budget. And spending on prescription drugs in Canada is not just slowing, but it is projected to stay the same in 2013 as it was in 2012 — a growth rate of zero (page ix). So spending money on anti-TNF drugs when they are warranted is not going to break the bank.
Most importantly, this report discusses only the money spent on medications. It does not take into account the money spent on hospitalizations and doctor visits (which have grown in cost since 2005 at a higher rate than the cost of drug spending, as explained on page ix of the report). It also does not take into account money spent on sick leave, or the dollar value of work lost to being sick because of the symptoms that anti-TNF medications treat. The dollars spent on effective medications are actually fairly cost-effective when all the costs of dealing with active Crohn’s and other autoimmune diseases are taken into account. And, if quality of life is factored in as well, the price seems even more reasonable.
So being part of the 12% of Canadians using the most costly prescription drugs isn’t so bad. It’s not like I aimed to be here. I’d rather be one of the 12% than on disability or dead.
I just hope that when my doctor and I apply to the Exceptional Access Program to increase the frequency of my Remicade treatments — I miss about 2 weeks of work every treatment cycle as the medicine wears off — my application will be approved. If not, it will be back to the Ombudsman’s office to complain about systemic problems caused by the siloing of government departments that would do a better job of serving the public — and saving money — by working together. The system will function best when it takes into account all the costs of uncontrolled Crohn’s disease, not just the costs of the medicine used to treat it.
* excluding Quebec, and data from several other provinces is incomplete.