Characterizing Publicly Funded Medication Utilization and Expenditures for Individuals with Rheumatoid Arthritis of All Ages in Ontario

Objectives Canadian provincial drug funding programs provide universal coverage for prescription medications for adults aged 65+ years, while younger adults can be eligible for publicly funded coverage based on financial need, high medication costs, disability status, or long-term/home care status. Within a population-based rheumatoid arthritis (RA) cohort, we characterized trends in total annual RA medication claims and expenditures across public drug programs and age groups. Methods Using a population-based repeated cross-sectional study design, we ascertained medication dispensation claims from the Ontario Drug Benefit (ODB) database from 2000 to 2022, among individuals with RA identified from the Ontario Rheumatoid Arthritis Database. For each year, RA individuals were required to be alive, 20 years or older, with Ontario Health Insurance Plan coverage, and contributed to annual RA population denominators from diagnosis until death, outmigration, or end of study. RA-related medication claims included biologic, conventional synthetic, or targeted DMARDs, NSAIDs, opioids, and systemic glucocorticoids. ODB funding programs included seniors (for 65+), Ontario Disability Support Program, Trillium/Exceptional Access Program (for high-cost medications), Ontario Works (for unemployment), and a combination of other programs. Analyses included trends in annual number of RA medication claims and cumulative medication expenditures, stratified by funding programs and age groups. Results From 2000 to 2022, the RA population increased from 60,781 individuals [34,394 aged <65); 26,387 aged 65+] to 154,675 individuals [74,182 aged <65; 80,493 aged 65+)]. Among those under 65, the number of individuals with at least one ODB-related RA medication claim rose from 5,069 (15%) in 2000 to 13,121 (18%) in 2022. For RA individuals aged 65+, the number of individuals with at least one ODB-related RA medication claim increased from 22,476 in 2000 to 63,293 in 2022 (representing 78-86% of eligible RA seniors across all years). Trends in total claim volumes and expenditures by age groups are depicted (Figure 1). Total RA medication expenditures peaked in 2022 at $256,907,248 for all ages ($78M under 65, $179M in 65+). Among funding sources, the ODB Seniors Program accounted for the largest share of claims, followed by the Disability and Trillium programs. Conclusion Ontario has seen a significant growth in publicly funded RA medication utilization and spending overtime. Among working-age individuals, nearly 1 in 5 had at least one RA medication claim, while most RA seniors consistently accessed treatment. The substantial increase in RA medication utilization and expenditures alongside the growing RA population underscores the need for more sustainable healthcare planning.