Latest Thinking

Pipeline products and plan sponsor impact

February 1, 2013

Shazia Syed, ACPR, BSc.Phm
Source: Perspective Winter 2013 – by TELUS Health

The pharmaceutical landscape is changing as is the profile of blockbuster drugs (i.e. global sales totaling $1 billion dollars or more). Blockbuster drugs historically impacting millions of chronic disease sufferers are remnants of the past, with the future forecasted profile of blockbuster drugs set to come to market teeming with novel therapies aimed at the specialty disease market and its niche—a smaller patient population but higher associated price tag. The shift in research and development towards specialized indications, with minimal generic exposure due to a paucity of treatment alternatives, comes hand in hand with another trend: oral medications for diseases previously dominated by treatments requiring injections or infusions. Examples include the approval of the first oral multiple sclerosis drug, Gilenya, in 2011, and the approval of four new oral cancer medications in 2012 alone (Inlyta, Xalkori, Zelboraf and Jakavi). This trend is expected to blossom in the near future and is of importance to plan sponsors with the greying of the line between the public payer and the plan sponsor as to who is responsible for paying. A larger proportion of expenditure for disease treatments once solely encompassed under the public provincial payer umbrella is expected to fall to the plan sponsor. There will also be the inevitable impact of expensive game changers for the rare, but costly specialty disease classes. In continuation with the Spring 2012 issue of Perspective, we present some noteworthy pipeline products.

Pipeline products and plan sponsor impact table 1

Pipeline products and plan sponsor impact table 2

* Biological Products as defined by Health Canada National Drug Schedule “D”

We continue to advise carriers to keep an eye out for noteworthy products first introduced in the Spring 2012 Perspective: XELJANZ (Tofacitinib), the first new oral anti-inflammatory drug for Rheumatoid Arthritis in over a decade, which recently received FDA approval and Dapagliflozin, a first-in-class medication (still under FDA review) targeting a novel pathway to reduce blood sugar levels in diabetic patients.

Plan sponsor impact

The influx of high-cost specialty drugs, with potential for further cost shifting to the plan sponsor as payer due to the availability of oral formulations, necessitates consideration of strategies to minimize the anticipated impact on plan sponsors. TELUS Health currently offers several drug plan management approaches—such as the Enhanced Biologics Formulary and Prior Authorization Program—and proactively looks to develop new programs to suit the needs of carriers in light of the changing pharmaceutical landscape.


i McBride, R and Caroll John. Fierce Biotech 15 top blockbuster contenders October 2012 .
http://www.fiercebiotech.com/special-reports/top-15-blockbuster-contenders/quad-top-15-blockbuster-contenders

ii Public Health Agency of Canada. Hepatitis C in Canada: 2005-2010 Surveillance Report. Centre for Communicable Diseases and Infection Control, Infectious Disease Prevention and Control Branch,
Public Health Agency of Canada; 2011. http://www.catie.ca/sites/default/files/1109-0139-Hep%20C%20Report-EN%20FINAL.pdf

iii Berstein: Another De-Risking – Apremilast Meets Endpoints; Now Targeting a $1.5bn Market, November 2012.
http://www.investorvillage.com/ smbd.asp?mb=341&mn=173312&pt=msg&mid=12302716

iv Decision Resources’ Updated Rheumatoid Arthritis Report Now Includes Forecast for Rigel Pharmaceuticals’ Fostamatinib Disodium. http://www.prnewswire.com/news-releases/decision-resourcesupdated-rheumatoid-arthritis-report-now-includes-forecast-for-rigel-pharmaceuticals-fostamatinib-disodium-62170922.html