Claims for thyroid and diabetes drugs, as well as antidepressants and cancer treatments, were among the highest in 2024. Claims for anti-inflammatory drugs were the most costly.
This was the consensus of the three insurers at the Drug Trends: What's Affecting Costs panel, which opened the Congrès Collectif 2025 (Group insurance conference) held in Montreal on Feb. 27.
At Beneva, claims related to the treatment of Attention Deficit Hyperactivity Disorder (ADHD) were the most numerous, reveals Gabrielle Côté, Pharmacist, Pharmaceutical Expertise and High-Cost Drug Management, Group Insurance, at Beneva. Côté explains that the proportion of adults using medication to treat ADHD tends to match that of children and adolescents.
According to Côté, the proportion of adults has increased due to greater awareness. “Often, we found that the parents of diagnosed children also had ADHD, which led to an increase in claims.”
Marie-Hélène Dugal, Manager, Pharmacy Benefit Strategy, Medavie Blue Cross, observed in her plans that consumption of ADHD medication increased among adults from 2019 to 2024. "This is particularly the case among women and people from Generations X and Y. It could be disorders that went unnoticed earlier, or that manifest themselves due to changes associated with menopause or perimenopause, thanks to greater awareness of the variety of symptoms," suggests Dugal.
Among other frequent claims, Dugal adds that drugs are coming onto the market to treat respiratory diseases, at an increasingly high cost.
Frédéric Leblanc, a pharmacist and Strategic Leader, Drug Programs at iA Financial Group, observes similar trends to those identified by Côté and Dugal. In addition to the frequency of claims, he says he is particularly interested in the evolution of costs. “Drugs like Synthroid (an AbbVie drug used to treat hypothyroidism) are extremely widespread and reimbursed, but are not problematic in terms of expenditure,” observes Leblanc.
Molecule of the decade
Semaglutides have revolutionized the management of type 2 diabetes and obesity - Gabrielle Côté
The arrival of GLP-1 receptor agonists has flooded drug plans with claims. Also known as semaglutides, these drugs are Novo Nordisk's Ozempic and Wegovy, and Eli Lilly's Mounjaro. In Canada, Ozempic and Mounjaro are used to treat type 2 diabetes, and Wegovy to treat obesity. “Semaglutides have revolutionized the management of type 2 diabetes and obesity,” says Gabrielle Côté. Type 2 diabetes prevents the body from properly using the insulin it produces.
She points out that studies recommend broadening the therapeutic indications of these drugs. A drug's indications refer to the symptoms or disorders on which it can act. According to Côté, GLP-1 agonists could indeed treat comorbid conditions.
In its benchmark bulletin, 2025 Health Trends and Insights, Beneva writes that obesity is a major risk factor for over 200 chronic diseases, including cardiovascular disease, type 2 diabetes, hypertension, cancer, respiratory disease and mental health disorders.
“We won't hear the last of them in the next decade,” says Côté, who predicts a multiplication of this type of drug. She says she is keeping a close eye on the positive effects that this wave of new diabetes treatments could have, and on the expansion of their therapeutic indications.
Semaglutide generics and biosimilars could appear in the next few years - Marie-Hélène Dugal
GLP-1 receptor agonists began to be patented several years ago, says Marie-Hélène Dugal. “Semaglutide generics and biosimilars could appear in the next few years,” she anticipates.
Dugal predicts that these cheaper drugs will encourage insurers to reimburse them for a greater number of therapeutic indications. In this respect, Frédéric Leblanc notes that studies are underway on GLP-1 agonists for the treatment of Alzheimer's disease.
Beneva and other insurers followed suit. Gabrielle Côté says the demand generated by Ozempic's ads led the insurer to rethink its prior authorization strategy, previously reserved for drugs costing $10,000 or more. This is the threshold for specialty drugs.
"We realized that we shouldn't just focus on expensive drugs, but also on less expensive ones. For example, drugs costing between $3,000 and $5,000 a year are likely to have a big impact if they generate a lot of requests," she explains.
Marie-Hélène Dugal, for her part, speaks of the phenomenon of drugs for common diseases “whose price approaches the psychological threshold of specialty drugs.” She cites the case of Mounjaro, approved by Health Canada in 2021 for the treatment of type 2 diabetes. “Taken at its maximum dose, the price of this diabetes drug can approach $10,000,” notes Dugal.
The increasing use of this drug at this dose could hurt group plans. She believes that prior authorization of this drug helps to strike a balance between cost and delay in the insured's treatment. “Things calmed down in 2024 on the diabetes side, since insurers put measures in place to ensure that diabetes drugs are used... to treat diabetes,” notes Dugal.
Inflammatory diseases
As for the most costly drug claims, the panelists pointed the finger at inflammatory diseases. At Medavie Blue Cross, Marie-Hélène Dugal notes that “inflammatory diseases are leading the way…That's where the growth in plan spending is coming from.”
This is also the case with Beneva's plans. Gabrielle Côté mentions Trikafta, from Vertex Pharmaceuticals. Trikafta treats cystic fibrosis and can cost around $300,000 a year per patient, reports Côté. Trikafta began to be marketed in Canada in June 2021.
Côté says that Trikafta's therapeutic indications have expanded to include other inflammatory diseases, such as rheumatoid arthritis, Crohn's disease, ulcerative colitis and psoriasis. “Inflammatory diseases put a lot of pressure on plans,” she says.
Frédéric Leblanc agrees. “Inflammatory diseases combined with diabetes account for nearly 25% of plan expenses in Canada,” he adds. “We need to manage anti-inflammatory drugs through prior authorization, and ensure better use of biosimilars where possible,” says Leblanc.
