The amount reimbursed for drugs by public drug plans in Canada increased by 7.9% between 2021-2022 and 2022-2023, according to the CompasRx report published in October 2025 by the Patented Medicine Prices Review Board (PMPRB). The pace of cost increases is accelerating. Last year's CompassRX report showed a 6.8% increase in 2021-2022 compared to 2020-2021.
The results cover the following plans: British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, New Brunswick, Nova Scotia, Prince Edward Island, Newfoundland and Labrador, and Yukon. These plans participate in the National Prescription Drug Utilization Information System (NPDUIS), which provides their data to the PMPRB.
The 7.9% increase in costs relates to the price of prescription drugs themselves. It does not include prescription dispensing costs, which come from expenses such as pharmacist fees. Drug costs accounted for 83% of prescription drug spending. Prescription dispensing costs accounted for 17%.
Taking into account both parts of the price of prescribed drugs, the increase is actually 7.4% in 2022-2023 compared to 2021-2022. This means that the cost of the drugs themselves has increased more than the cost of filling prescriptions. The total cost of prescription drugs reached $14.1 billion ($B) at the end of the comparison period.
Between 2017-2018 and 2022-2023, total spending on prescription drugs increased by $3.4B, a compound annual growth rate of 5.9%.
Under pressure from a handful of beneficiaries
The growth was primarily driven by a sustained increase in the use of higher-cost drugs.
– Patented Medicine Prices Review Board (PMPRB)
To explain the 7.9% increase in drugs themselves, the PMPRB points to drugs costing more than $10,000 and the increase in the number of beneficiaries. “The growth was primarily driven by a sustained increase in the use of higher-cost drugs, coupled with a post-pandemic rebound in active beneficiaries,” the report found.
The total number of active beneficiaries of the NPDUIS public plans increased by 7.4% between 2021-2022 and 2022-2023, reaching 6.6 million. The report notes that this is a return to the growth trend seen prior to the COVID-19 pandemic.
Expenses for high-cost drugs come from a small number of insured individuals, the PMPRB points out. In the 2022-2023 period, drugs costing more than $10,000 per year were used by less than 3% of beneficiaries and accounted for more than 37% of drug costs. In the same period, drugs costing more than $25,000 per year were used by less than 1% of beneficiaries.
Of the 6.6 million active beneficiaries in plans tracked by the NPDUIS, 7.6% used drugs with an annual cost exceeding $5,000 in 2022-2023. They accounted for 62.3% of the total drug costs covered by public plans during that period.
Not just the most expensive
In terms of spending, the CompasRX report reveals that Trikafta ranked first for the 2022-2023 period, after only two years on the market. The reason: the treatment costs more than $200,000 per year, and its usage is growing rapidly. Trikafta is a drug for the treatment of cystic fibrosis.
Five of the other drugs that contributed most to spending were high-cost drugs with average annual treatment costs ranging from $18,426 to $121,279. Among them was a non-steroidal antiandrogen, a drug mainly used to treat prostate cancer. The PMPRB report also mentions an oral oncology product, a drug for the nervous system, and two immunosuppressants.
However, expensive drugs are not the only reason for public plan drug cost increases. According to the PMPRB report, three antidiabetic drugs were included on the list of drugs with a high impact on costs. Together, they accounted for 1.8% of the growth in drug costs. These drugs are semaglutide (Ozempic), empagliflozin (Jardiance), and dapagliflozin (Forxiga).
Private plans are not immune
Expensive drugs are also putting pressure on private group insurance plans, which are provided by insurance companies.
The average claim amount in private plans reached $1,037.95 in 2024, an increase of 3.3% from the average amount of $1,005.03 observed in 2023, according to the TELUS Health 2025 Drug Data Trend & National Benchmark Report, a leading provider of payment solutions for insurers and private plan sponsors in Canada.
In 2015, the average annual amount was only $667.78, notes the TELUS Health report. “We forecast an annual growth rate of between 3% and 8% for the next five years, due to a combination of increased utilization and more high-cost drugs,” says Vicky Lee, Director, Pharmacy Consulting & Professional Services, Payor Solutions, TELUS Health.
Among other major payment solution providers, Express Scripts Canada noted that spending per claimant increased by 3.1% in its 2025 Drug Trend Report. The report reveals a 5.8% increase in the overall drug trend.
It shows that the percentage of plan participants who submitted at least one claim (request for reimbursement) for a specialty drug increased by 15.7%. “The rising trend for specialty drugs can be explained by the increasing number of speciality drugs and newly approved indications for drugs that target inflammatory, skin conditions and cancer as well as the growing trends for Trikafta,” writes Express Scripts Canada.
At the time of writing, insurer GreenShield's 2025 drug trends report was not yet available. It is usually released in November. In its 2024 Drug Trends Report, the insurer noted that 53.6% of costs were incurred by 5% of plan participants in 2023. In the same year, 30.8% of costs came from 1% of participants.
