Catastrophic drug coverage: utilization insights from the Ontario Trillium Drug Program

Mina Tadrous; Simon Greaves; Diana Martins; Muhammad M. Mamdani; David N. Juurlink; Tara Gomes

doi:10.9778/cmajo.20170132

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Figure 1
Rate of Ontario Trillium Drug Program beneficiaries per 1000 and total program spending from 2000 to 2016, by year and quarter.
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Figure 2
Percentage of Ontario Trillium beneficiaries from 2000 to 2016 with any single claim over $1000, by year and quarter.

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Table 1: Characteristics of the Ontario Trillium Drug Plan and its beneficiaries in calendar years 2000, 2005, 2010 and 2015

Characteristic	Year
Characteristic	2000	2005	2010	2015
No. of TDP recipients	55 571	95 296	162 301	176 299
No. of TDP recipients surpassing deductible, n (%)	51 320 (92.4)	90 564 (95.0)	150 229 (92.6)	163 140 (92.5)
Total TDP spending, $	65 717 445	170 049 300	281 546 814	416 019 977
Average annual cost per recipient surpassing deductible, $	1281	1878	1874	2550
Median age, yr (Q1-Q3)	53 (43-63)	53 (43-63)	52 (41-63)	52 (40-64)
Age category, yr, n (%)
0-24	7507 (13.5)	14 099 (14.8)	27 020 (16.6)	30 943 (17.6)
25-34	3387 (6.1)	5554 (5.8)	10 633 (6.6)	13 504 (7.7)
35-49	11 849 (21.3)	20 286 (21.3)	34 194 (21.1)	35 024 (19.9)
50-64	32 828 (59.1)	55 357 (58.1)	90 454 (55.7)	96 828 (54.9)
No. of drugs, n (%)
1	5,773 (11.2)	10 942 (12.1)	21 460 (14.3)	29 662 (18.2)
2	5,765 (11.2)	10 373 (11.5)	18 115 (12.1)	19 731 (12.1)
≥ 3	39 782 (77.5)	69 249 (76.5)	110 654 (73.7)	113 747 (69.7)
Sex, male, n (%)	22 767 (41.0)	39 801 (41.8)	69 976 (43.1)	77 551 (44.0)
Income quintile, n (%)
1 (lowest)	14 838 (26.7)	26 628 (27.9)	44 417 (27.4)	45 789 (26.0)
2	13 465 (24.2)	22 366 (23.5)	37 289 (23.0)	40 225 (22.8)
3	10 856 (19.5)	18 212 (19.1)	32 319 (19.9)	35 898 (20.4)
4	9183 (16.5)	15 751 (16.5)	27 847 (17.2)	31 493 (17.9)
5 (highest)	7127 (12.8)	12 123 (12.7)	20 082 (12.4)	22 492 (12.8)
Charlson Comorbidity Index score, n (%)
No hospital admission	35 058 (68.3)	66 600 (73.5)	117 491 (78.2)	131 290 (80.5)
0	7869 (15.3)	12 514 (13.8)	16 238 (10.8)	15 572 (9.6)
1	3873 (7.6)	5242 (5.8)	6886 (4.6)	6523 (4.0)
≥ 2	4520 (8.8)	6208 (6.9)	9614 (6.4)	9755 (6.0)
Single claims > $1000	1757 (3.4)	5170 (5.7)	10 021 (6.7)	17 015 (10.4)
Any biologic use	4119 (8.0)	8397 (9.3)	15 985 (10.6)	21 779 (13.4)
High-cost biologics	807 (1.6)	2711 (3.0)	5061 (3.4)	8952 (5.5)
Deductible, n (%)
Low (< $350)	50 180 (97.8)	86 055 (95.0)	139 489 (92.9)	150 092 (92.0)
Med ($351-499)	699 (1.4)	2468 (2.7)	5595 (3.7)	5895 (3.6)
High (> $500)	441 (0.9)	2041 (2.3)	5145 (3.4)	7153 (4.4)
Median deductible, $	42	65	69	58

Note: All characteristics were found to be statistically significant for tests of trend from 2000 to 2015 (p < 0.05). TDP = Trillium Drug Plan.

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Table 2: Top 10 drugs by use and cost in calendar years 2000, 2005, 2010 and 2015

Rank	Year
Rank	2000	2005	2010	2015
Top drugs by frequency of use, n* (%)
1	APAP, caffeine and codeine 9119 (16.4)	Atorvastatin 18 014 (18.9)	Metformin 26 486 (16.3)	Rosuvastatin 27 452 (15.6)
2	Amoxicillin 7367 (13.3)	APAP, caffeine and codeine 14 069 (14.8)	Atorvastatin 24 940 (15.4)	Amoxicillin 24 686 (14.0)
3	Estrogen 7097 (12.8)	Amoxicillin 13 437 (14.1)	Amoxicillin 23 214 (14.3)	Metformin 23 990 (13.6)
4	Atorvastatin 6293 (11.3)	Metformin 13 321 (14.0)	Rosuvastatin 22 419 (13.8)	Atorvastatin 19 859 (11.3)
5	Ranitidine 6260 (11.3)	Ramipril 13 207 (13.9)	APAP, caffeine and codeine 18 459 (11.4)	Albuterol 19 571 (11.1)
6	Albuterol 5575 (10.0)	Albuterol 10 226 (10.7)	Ramipril 17 330 (10.7)	Levothyroxine 16 865 (9.6)
7	Lorazepam 5427 (9.8)	Hydrochlorothiazide 10 023 (10.5)	Albuterol 17 016 (10.5)	APAP, caffeine and codeine 14 435 (8.2)
8	Levothyroxine 5283;(9.5)	Levothyroxine 9141 (9.6)	Levothyroxine 15 297 (9.4)	Amlodipine 14 258 (8.1)
9	Metformin 4862 (8.7)	Lorazepam 8183 (8.6)	Rabeprazole 13 904 (8.6)	Pantoprazole 13 868 (7.9)
10	Glyburide 4292 (7.7)	Amlodipine 7702 (8.1)	Amlodipine 13 418 (8.3)	Ramipril 12 380 (7.0)
Top drugs by total spending, $† (%)
1	Atorvastatin 2 600 000 (4.0)	Infliximab 10 450 000 (6.1)	Infliximab 31 830 000 (11.3)	Infliximab 55 370 000 (13.3)
2	Interferon α2b and ribavirin 2 240 000 (3.4)	Atorvastatin 7 900 000 (4.6)	Etanercept 11 070 000 (3.9)	Ledipasvir and sofosbuvir 24 620 000 (5.9)
3	Interferon β 2 080 000 (3.2)	Interferon β1a 7 000 000 (4.1)	Interferon β1a 9 339 000 (3.3)	Adalimumab 23 520 000 (5.7)
4	Interferon β1a 2 050 000 (3.1)	Imatinib 4 980 000 (2.9)	Oxycodone 8 180 000 (2.9)	Etanercept 14 340 000 (3.4)
5	Omeprazole 1 970 000 (3.0)	Etanercept 4 700 000 (2.8)	Adalimumab 8 100 000 (2.9)	Tenofovir 10 900 000 (2.6)
6	Olanzapine 1 710 000 (2.6)	Olanzapine 3 920 000 (2.3)	Imatinib $6 900 000 (2.5)	Eculizumab 10 040 000 (2.4)
7	Lamivudine 1 700 000 (2.6)	Lamivudine and zidovudine 3 280 000 (1.9)	Rosuvastatin 6 500 000 (2.3)	Interferon β1a 73 760 000 (1.8)
8	Nelfinavir 1 420 000 (2.2)	Oxycodone 3 250 000 (1.9)	Atorvastatin 6 420 000 (2.3)	Efavirenz, emtricitabine and tenofovir 71 010 000 (1.7)
9	Stavudine 1 400 000 (2.1)	Ramipril 3 060 000 (1.8)	Efavirenz, emtricitabine and tenofovir 6 350 000 (2.3)	Sofosbuvir 6 740 000 (1.6)
10	Lamivudine and zidovudine 1 360 000 (2.1)	Omeprazole 3 040 000 (1.8)	Abacavir and lamivudine 5 000 000 (1.8)	Lenalidomide 6 720 000 (1.6)