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

Background — Catastrophic drug coverage programs help those with high drug-costs to reduce the burden of out of-pocket expenses. We set out to measure changes in utilization, spending and demographic profiles of people accessing Ontario’s catastrophic drug program, the Trillium Drug Program.

Methods — We conducted a cross-sectional time-series analysis examining quarterly utilization and spending trends among medications reimbursed by the Trillium Drug Program in Ontario, Canada from January 1, 2000 to December 31, 2015. In each of 2000, 2005, 2010, and 2015, we described the population of beneficiaries, including demographic information, healthcare utilization, and medication utilization.

Results — Over our study period, use of the Trillium Drug Program increased 3-fold from 3.6 beneficiaries per 1,000 to 10.9 beneficiaries per 1,000 Ontarians, and total government spending on the program increased by over 700%, reaching $487 million in 2015. Between 2000 and 2015, more beneficiaries were under the age of 35 (19.6% to 25.3%; p<0.0001), did not have a hospitalization (68.3% to 80.5%; p<0.0001), and had high deductibles (2.3% to 8.0%; p<0.0001). Further, there has been a large increase in the proportion of users with drug claims greater than $1,000 (3.4% to 10.4%; p<0.0001) and those dispensed a high-cost biologic (1.6% to 5.5%; p<0.0001).

Interpretation — Increasing use of Ontario’s catastrophic drug program highlights the growing burden of high drug prices for Canadians. With a growing number of expensive drugs being approved in Canada, we anticipate that spending and use of the catastrophic drug program will continue to expand.