Mutual insurance company, Beneva has released its 2025 Health Trends and Insights report, which discusses the pressures that innovative medicines are placing on health insurance plans, but which also encourages plan sponsors to look past the immediate costs to realize the longer-term benefits of providing coverage.
Entitled Connecting the Dots, the report says since Beneva entered the Canadian market in May 2024 it has reimbursed $10.2-million in claims for Wegovy, an amount that could exceed $25-million in 2025. They also say the number of people suffering from type 2 diabetes has grown by almost five per cent each year between 2015 and 2024. “The average yearly claim cost of diabetics is nearly 3.7 times more than for non-diabetics ($3,300 compared to $900),” they write.
Finally, they say total spending on cancer therapies almost quadrupled between 2014 and 2024, with the average cost of treatment nearly doubling from $7,800 to $14,700 over the same period.
A shift in long-term disability claims
The report looks in depth at obesity, diabetes, inflammatory bowel disease, cancer and dementia and Alzheimer’s, along with the impact developments and innovations related to each condition have on group plans. Beneva also says its researchers have noted a significant shift in long-term disability claims. “Over the past two decades, claims for physical conditions, such as cancer and musculoskeletal disorders, have decreased by 15 per cent, while claims for psychological conditions have surged by nearly 40 per cent,” they write.
Sustainability, they say, is the primary challenge for plan sponsors in 2025. They also note that in the case of semaglutide GLP-1 therapies, the innovations are not limited to obesity treatment, as there are currently clinical trials underway to explore their potential in treating other conditions, including sleep apnea, Alzheimer’s and cancer. In 2024, Health Canada approved the use of Wegovy to prevent heart attacks.
Increased productivity
The positive outcomes of the drug’s usage include fewer workplace absences, increased productivity and a reduction in co-morbidities, which they say will ultimately offset the short-term rise in costs.
To help manage in the interim, Beneva recommends biosimilar substitutions, a pharmacoeconomic evaluation process for new drugs, along with a focus on the longer-term benefits the drugs could yield in the future.
“By focusing on strategic decision-making and careful planning, we are reducing costs and improving overall value,” they write. “Advisors play a pivotal role in helping plan sponsors see these therapies as an opportunity, transforming expenses into investments that yield lasting benefits.”
