Which 3 therapeutic categories are having a big impact on Canadian benefit plans in 2023?

Report reveals 'overall rise in utilization rates'

BY Jim Wilson 23 Oct. 2023

More workers are taking advantage of the drug coverage in their health benefits, according to a recent report.

The total drug costs adjudicated by GreenShield Administration rose to $2.2 billion in 2022, up from $1.4 billion in 2018.

During that period, the number of claimants rose to 2.3 million from 1.8 million.

“The average drug cost per claim has grown steadily since 2018; except in 2020, when temporary COVID-19-related policies allowing shorter days’ supply (i.e., 30 days) were implemented reducing the average days’ supply per claim and resulting in a lower drug cost per claim," read part of the GreenShield report. "Once these policies were lifted during the second half of 2020, the average days’ supply normalized and subsequently resulted in a greater drug cost per claim in 2021 and 2022 compared to 2020.”

The number of overall drug claims surpassed 32 million in 2022, with 2.3 million claimants. More than half (53.5 per cent) of the total adjudicated GreenShield Administration drug cost was associated with the top five per cent of claimants, and 31.1 per cent was associated with the top one per cent of claimants.

In the ever-changing world of healthcare, this report “reveals a compelling narrative, with an overall rise in utilization rates - driven by new therapies and changes in how plan members approach their health," said Mark Rolnick, executive vice president, head of GreenShield Administration.

Overall, 49 per cent of workers employed by small employers would choose health benefits over the extra cash, found a previous survey by Blue Cross of Canada.

Disease states by share of total drug cost

Among the top one per cent of claimants, drug claimants have the following disease states:

Disease state	Share of total drug cost	Share of claimants
RA/Crohn’s/colitis/ psoriasis	40.9 per cent	54.0 per cent
Cancer	12.0 per cent	18.9 per cent
Multiple sclerosis	6.9 per cent	8.8 per cent
Cystic fibrosis	5.5 per cent	1.3 per cent
Asthma and COPD	4.4 per cent	29.2 per cent

The data for the top five per cent are as follows:

Disease state	Share of total drug cost	Share of claimants
RA/Crohn's/colitis/ psoriasis	26.5 per cent	22.5 per cent
Diabetes	10.1 per cent	38.8 per cent
Cancer	8.4 per cent	10.3 per cent
Multiple sclerosis	4.6 per cent	2.6 per cent
Asthma and COPD	4.3 per cent	29.0 per cent

Canadian employers lose about $237 million annually in lost productivity due to menopause, and it costs women $3.3 billion in lost income due to a reduction in hours or pay or leaving the workforce altogether, finds the Menopause Foundation of Canada.

Therapeutic categories and 2023 costs

The 2023 Greenshield Administration Drug Trends Report also identified three therapeutic categories that are likely to have a high impact on benefit plans in 2023:

The number of ADHD claimants grew by 15 per cent, with six of every 100 GreenShield Administration claimants using ADHD medications in 2022.
New biologic treatments – anti-CGRPs (calcitonin gene-related peptide), such Aimovig, Ajovy, and Emgality – have increased existing migraine patients' overall drug cost by 132 per cent over the last three years.
Medications primarily used for asthma and COPD were claimed by 16 per cent, or 382,000 of claimants in 2022.

The expected rise in medical costs for employers next year should be smaller than last year, according to a recent survey done by Aon. The report pegs the average medical trend rate for 2024 to be 5%, which is lower than 2023’s rate of 7.5%.