Issue link: http://read.uberflip.com/i/1513142
Off-label prescribing leaves mark in diabetes. No matter how you slice it, drugs for diabetes are steadily claiming a greater share of the spend for private drug plans—so much so that the category (including diabetes devices) took over the number-one position on TELUS Health's top-10 list of drug categories in 2022, accounting for 12.9% of total eligible amounts submitted to drug plans. While an explosion in off-label use of one of the diabetes drugs— Ozempic—for weight loss is a big factor behind the trend, it's also important to note that prescribing has increased for certain classes of diabetes drugs, which have proven their ability to help manage the disease. The share of all claimants submitting claims for a diabetes drug grew from 5.9% in both 2018 and 2019 to 7.4% in 2022 (chart 1). The first six months of 2023 saw the biggest jump yet in the share of all claimants, to 8.9%. Stepping back to spread out these claims across all insured individuals (whether or not they made any claim at all), diabetes drugs represented 4.3% of TELUS Health's book of business in 2022, up from 3.3% in 2018. For the first six months of 2023, that climbed further to reach 5.7%. As a share of all claims, diabetes drugs climbed from 4.4% in 2018 to 5.3% in 2022, and to 5.8% for the first six months of 2023 (chart 2). The last two years saw significant gains in the number of claimants for diabetes drugs, with 17.4% more claimants in 2021 and 21.8% more in 2022 (chart 3). Increased diagnoses are one factor. A 2022 report from the Public Health Agency of Canada stated that more than three million Canadians, or 8.9% of the population, now live with diabetes. After adjusting for an aging population, the prevalence of diabetes is climbing at an average rate of 3.3% annually. Prescribers are also responding to evidence that second- or third-line therapies can and should begin sooner than later for some patients. "Treatment guidelines have changed, and now patients with high average blood-sugar levels and comorbidities can be started on combination therapies right off the bat, whereas before they might have been started on the first-line therapy only," says Lee. In 2020, the growth rate in the number of claims (13.3%) significantly outpaced growth in the number of claimants (2.2%) (charts 3 and 4). "This likely reflects provincial recommendations to pharmacies during the early months of the pandemic to reduce prescription refills to 30 days rather than the usual 90 days for maintenance therapies," says Lee. P. 4