Top 10 drugs in 2022

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 2022 top ranking once again demonstrates the evolution of medical practice, pharmaceutical innovations and their impact on:

• Costs
• Drug use
• Member health

The top 10, which now includes six specialty drugs, account for 24% of total spending for the year, up 2% from 2021, yet the number of claims for these ten drugs is down 1% (4.5% in 2022 vs. 5.4% in 2021).

Top 10 drugs in a nutshell
The table below shows the top 10 drugs by amounts reimbursed in 2022, in descending order, and their respective rank in 2021 and in 2020.

As a result, the impact of specialty drug costs on spending continued in 2022 with the arrival of a new drug, TRIKAFTA. TRIKAFTA is a very expensive drug used to treat a relatively rare disease, cystic fibrosis. In 2022, we saw a significant increase in the number of insured who began using this drug to alter the course of this dismal prognosis disease. Its use appears to be stabilizing since patients have been able to access the treatment.

We also observe two significant trends: the first is the marked rise of the drug OZEMPIC to the top spot. The second is the demotion of the drugs REMICADE and HUMIRA (and their biosimilars). OZEMPIC has overtaken REMICADE and HUMIRA, which had been at the top of the list for several years.

OZEMPIC
Recently, there has been a lot of attention paid to the antihyperglycemic agent OZEMPIC, both in the mainstream and specialized media and on social media. The active ingredient in this drug, semaglutide (OZEMPIC, RYBELSUS, WEGOVY), is a special case, as it is a molecule with two indications that may be complementary.

Indeed, semaglutide marketed under the names OZEMPIC and RYBELSUS is indicated for the treatment of type 2 diabetes. Semaglutide under the name WEGOVY is also approved (but not yet commercialized) as an adjunct to diet and increased physical activity for weight management in patients who are obese (BMI of 30 kg/m2 or more) or overweight (BMI greater than 27 kg/m2) and who have at least one weight-related comorbidity.

Obesity (or overweight) and type 2 diabetes are closely linked. Indeed, it is estimated that 80-90% of people with type 2 diabetes are overweight. An important link between obesity and diabetes is insulin resistance, which is the decreased ability of insulin to allow glucose (sugar) to enter the cells and slow down the production of glucose by the liver. In addition, being overweight is a risk factor for prediabetes and type 2 diabetes.

The association and interrelation between type 2 diabetes and overweight or obesity certainly explains the interest of OZEMPIC for prescribers. In fact, we have seen a decrease in the use of other drugs for type 2 diabetes in favour of OZEMPIC.

It is possible that OZEMPIC is also used for weight loss and obesity treatment without diabetes, especially since WEGOVY is not available in Canada. However, it is difficult to estimate the extent of its use in this context.

From a medical and health management perspective, iA Financial Group recommends that treatments for obesity and overweight management be covered by drug plans on a managed basis.

In the current context of increasing use of OZEMPIC and the two recognized indications for semaglutide, we are implementing measures to encourage the appropriate use of OZEMPIC (see other article in this edition).

Switching to biosimilars
Our biosimilars transition strategy is working. Indeed, REMICADE and HUMIRA have dropped in the 2022 top 10 rankings. HUMIRA has dropped two places since 2020, when it was the number one drug in terms of reimbursement amounts. While our strategy has been in place for several years, 2022 was the most significant year, as we implemented our transition campaign in seven Canadian provinces, including Quebec.

Our initiatives were successful, as in some cases and in some regions, we achieved switching rates to biosimilars of 75% and even 80%. Our strategy has therefore been successful and the experience of the members has been considered excellent overall.

In this context, we are continuing our efforts in 2023, particularly in Ontario. In addition, we are now extending our transition campaigns to all insured persons across the country.

Also, following the successful results of our initiatives, we have put in place an ongoing process to transition to biosimilars as soon as they are available on the market. This will help us achieve savings as quickly as possible to the benefit of our clients.

Management strategies
Based on these observations and other key indicators, iA Financial Group develops effective management strategies for its clients, such as the biosimilars transition strategy and measures to ensure the appropriate use of OZEMPIC and FREESTYLE LIBRE.

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