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On April 23, 2024, Telus held its annual conference on Canadian prescription drug trends and benchmarks. The findings help us better understand the healthcare needs of insureds and be better equipped to manage costs without lowering the value of health insurance plans.

We will look at the trends observed since 2008, which was the year Telus began compiling the numbers and sharing them with the benefits industry.

It is important to note, however, that due to a change of supplier in data collection, annual drug trends are not available in this year's report. Data for the year 2023 will therefore be the new baseline for illustrating trends over the coming years.

Drug Cost and Utilization on the Rise

The following highlights on drug cost and utilization are key takeaways for plan administrators:

• Monthly refills. In Quebec, the trend of 30-day drug prescriptions persists, with an average eligible cost of $71.56 per claim. Elsewhere in Canada, where 60- to 90-day supplies are more prevalent, the average cost is $83.53. Average utilization is higher in Quebec because pharmacists generally propose monthly refills.
  
  
• Nearly 6 out of 10 insureds (58.7%) in Canada made at least one claim in 2023.
  
  
• Over the past 16 years, growth rates in the average annual eligible amount per claimant by age have been strong. The numbers also align with the probability of increased use of medications with age, although the rates of increase in the average annual eligible amount per claimant were significant across all age groups. 
  
  

• Indeed, the share of the total eligible amount for claimants aged 19 and under has grown since 2008. This increase is largely due to the larger number of treatment options and the higher-cost drugs that are now approved for this population. Moreover, the higher cost of sensors for type 1 diabetes, the prevalence of mental health issues and the growing use of antidepressants also contributed to this upswing.

Additionally, social media is held partially responsible for the uptick in youth mental health issues, which deserves particular attention in the coming years.

• In 2023, generic medications accounted for 67.5% of all medications covered by private plans. Single-source brand-name drugs accounted for 25.9% and multi-source brand-name drugs accounted for 6.6%. This last figure can serve as a benchmark for private drug plans concerning generic drug penetration rate.  
  
  
• Specialty drugs’ share of the total eligible amount plateaued in 2023 after more than 15 years of steady gains, except for a slight decline in 2022. This situation can be explained by the implementation of policies encouraging the use of lower-priced biosimilars. Specialty drugs’ share of the total eligible amount was 31.2% for 1.8% of claimants. This share has increased since 2008, when it accounted for 10.4% of the total eligible amount and 0.5% of claimants.

Higher-Priced Therapeutic Classes

Key points to remember with respect to drug categories include:

• Diabetes drugs and devices continue to lead the top-10 list of drug categories based on eligible amounts, i.e. before deductible and/or coinsurance. Inflammatory diseases, skin disorders, ADHD and depression round out the rest of the top five.

Note that the top-10 list includes both higher-incidence and relatively lower-cost categories (diabetes, depression, ADHD, asthma and high blood pressure) and categories with a lower incidence rate requiring much higher-priced drugs.

• Diabetes, which ranked fourth in 2008, has now remained in the top spot since 2022. The number of claimants jumped in recent years (increases of 24.9% in 2021, 28.5% in 2022 and 7.9% in 2023) reflecting a higher prevalence of type 2 diabetes and off-label use for weight management. Growth rates in the total eligible amount exceeded 20% in the last three years. As a result, the average annual cost per claimant jumped 19.9% in 2023. 

• By the end of 2023, one in five claimants was taking an antidepressant or medication for ADHD, resulting in this type of drug moving from sixth position in 2022 to fourth in 2023. The number of claimants jumped in recent years (43.9% in 2021 and 39.2 % in 2022), particularly due to the pandemic. They have increased more than eightfold between 2008 and 2023. The average annual cost per claimant grew from $608 in 2008 to $812 in 2023.

• Weight management is not yet in the top-10 list of drug categories. However, as obesity is now recognized as a chronic illness and new medications are being marketed to treat it, it is likely to generate a substantial cost increase for private plans in the coming years. Despite this potentially high impact on expenses, the benefits of such drugs on the quality of life and performance at work may prove just as consequential.

Things to Watch for in the Coming Years

With higher costs and the steadily increasing prevalence of certain conditions, particularly within the top 10 categories, some deep-set trends will warrant monitoring. 

Particular attention will need to be paid to diabetes, ADHD, depression, weight management and women’s health. With their major physical, mental and financial impacts, these conditions affect the productivity of insureds, the workplace presenteeism or absenteeism rates, and the private insurance plans.

Data should be analyzed to monitor your plan and cost management measures are worth implementing to mitigate such trends. 

The AGA team can help with the analysis of your situation. Do not hesitate to contact us - we’d be happy to answer any questions.