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Top 10 drugs in 2021

News Release

As part of the development and implementation of drug utilization management strategies, iA Financial Group tracks certain key indicators. One of them is the ranking of the ten drugs that account for the highest spending for all group insurance contracts in a year.

The 2021 top 10 ranking once again demonstrates the evolution of pharmaceutical innovations and their impact on:

  • Costs
  • Drug use
  • Member health

Indeed, the significant trend in the impact of specialty drugs on spending continued in 2021. The top 10, which includes six specialty drugs, account for 22% of total spending for the year, up 2% from 2020, yet the number of claims for these ten drugs is down 3% (5.4% in 2021 vs. 8.4% in 2020).

Impact of COVID-19
While the pandemic had a significant impact on claims in 2021, it did not directly impact the drugs in the top 10. Last year, the increase in claims for antidepressants continued, and the decrease in claims for the anti-infective category such as antibiotics, which we observed in 2020, continued. These observations demonstrate the impact of COVID-19 on mental health and the positive effects of health measures on the spread of other infectious diseases.

Top 10 drugs in a nutshell
The top 10 drugs can be divided into two categories:

  • Specialty drugs: expensive, often biologic drugs, for relatively infrequent conditions
  • Traditional drugs: affordable, generic drugs often available for common conditions

The table below shows the top 10 drugs by amounts reimbursed in 2021, in descending order, and their respective rank in 2020 and in 2019.

Specialty drugs
Specialty drugs are well represented in the top spots, with two new entries, the biologics DUPIXENT (dupilumab) and ENTYVIO (vedolizumab).

DUPIXENT treats inflammatory skin conditions (atopic dermatitis) and respiratory conditions (asthma and chronic rhinosinusitis with nasal polyps).

As for ENTYVIO, it treats inflammatory gastrointestinal conditions (ulcerative colitis and Crohn's disease). ENTYVIO has even been described as a selective anti-inflammatory biologic agent of the intestine. The growth of these two new drugs illustrates the unmet medical needs for these sometimes severe conditions that greatly affect the quality of life of those who suffer from them.

Significant savings are expected from the launch of several biosimilar versions of HUMIRA in 2021. Competition for market share will be intense for what is considered one of the most important “blockbusters” in pharmaceutical history.

Traditional drugs
OZEMPIC, a treatment for diabetes, is enjoying a phenomenal rise. Its favourable profile on patients' cardiovascular risk is no doubt a factor in its popularity. Its widespread use is also explained by the high prevalence of type-2 diabetes in connection with the aging population.

In diabetes, FREESTYLE LIBRE is ranked 6th in the 2021 ranking. Adding up the spending on FREESTYLE LIBRE and traditional strips, these diabetic supplies move to 3rd in reimbursement amounts. This category will be closely monitored.

We find CONCERTA in 4th place, and VYVANSE in 7th place, both of which have dropped one spot from 2020. These two drugs are used for the treatment of attention deficit disorder with or without hyperactivity (ADHD). Their high ranking is explained by their high use in Quebec, a significant disparity with other Canadian provinces.

Management strategies
Based on these observations, and other key indicators, iA Financial Group develops effective management strategies for its clients. We are actively working on initiatives to optimize the use of biosimilar drugs to better control costs. We are also working on various strategies related to glucose monitoring systems to encourage judicious use and control cost growth.

Finally, as these observations cover all claims processed by the Group Insurance sector of iA Financial Group, they do not necessarily apply to every drug plan we administer. We invite you to contact your advisor or your iA Financial Group Account Executive to discuss your plan and determine the best and most relevant strategies for you.

Frédéric Leblanc, Pharmacist
Strategic Leader, Drug Programs
Group Insurance