In a wide-ranging discussion about drug costs and extended health care benefits spending, experts from Medavie Blue Cross in a recent online discussion put figures to the trends they’re observing, in order to provide insight into the balance the benefits provider strikes in between health care needs and costs.
Biologic drugs, mental health and diabetes, all significant cost drivers, were each examined in some detail for the benefit of those gathered to hear the recent webinar, Drive your plans with data.
Specialty drugs
Biologic drugs in 2021 came in at 12.9 per cent of total spending, with an average cost per claimant around $20,000. “So far fewer claimants but much higher cost per claim,” says Medavie Blue Cross manager of health and digital product solutions, Colleen Adams.
Pharmacy consultant, Anne-Marie Smith adds that the new drug pipeline of medications to consider is filled with specialty drugs. “In fact, specialty drugs made up 76 per cent of all the drugs we reviewed last year through our medication advisory panel. We typically think of specialty drugs for rare conditions such as cancer or autoimmune conditions, but there are also specialty drugs for many chronic conditions today such as asthma, cholesterol and even eczema, just to name a few.” Biologic drug treatment for asthma, she adds, can cost approximately $25,000 per year. Although eye catching, she also points out that the drugs, although expensive, are generally only used to treat very small populations.
Diabetes
Far more prevalent among Canadians are incidents of diabetes. They say more than 11-million Canadians are currently living with diabetes or prediabetes.
Type two diabetes represents 90 per cent of all diabetes diagnosis, they say, adding that in Canada, about 50 per cent of those living with diabetes are over age 65. (In 2021, plan members over 65 outpaced total plan member population growth.) Today, they say diabetes represents a total of 10 per cent of health spending.
Up from just four per cent of the population living with diabetes in 2000, the incidence of diabetes has more than doubled in only two decades, Adams adds. “By 2021, 8.8 per cent of Canadians had been diagnosed with diabetes, with another 6.1 per cent at high risk for developing this lifelong condition.”
This increase not only increases the market for diabetes medications and supplies, it also drives research into newer drugs which, she points out, are more expensive than older drugs and their generic versions. “The combination of more claimants and more expensive treatments has resulted in double digit per capital growth for three years running,” Adams says. Smith adds that diabetes is the number two trend driver of growth for all private plan expenditures.
Mental health
Finally, they say mental health-related spending makes up 7.5 per cent of total spending, with antidepressants appearing in the list of top five drug categories for every demographic.
When it comes to antidepressant drug use, they say almost 14 per cent of unique plan members are now claiming for these medications. Of those, one third were first time claimants in 2021.
Mental health also continues to be the number one driver of disability claims. “A lot of the solutions we’re trying to deliver to the market focus on prevention,” Adams says. “Our goal is to help members early on so that it doesn’t become an issue that progresses to the point of a short or long-term disability claim. Again, we’re trying to make a bigger impact at the beginning of a mental health concern.”
As part of that effort, in its own plans, Medavie increased their $500 benefit to $1,000 for mental health and expanded the list of eligible practitioners. It also introduced a pharmacogenomic testing program as part of its approach to managing mental health disability claims.
Pharmacogenomic testing
“Pharmacogenomic testing, also known as personalized medicine, has also helped advance mental health treatment,” Adams says. “For mental health medication, this can be a game changer. It means members can often find the right mental health drug at the right dose, the first time.”
Overall, mental health utilization jumped 34 per cent in 2021. Adams also points out that some of the youngest plan members are in fact using mental health resources more than massage, vision and physiotherapy. “They’re taking care of their minds. Also keep in mind that this generation is digital native. When considering solutions in your plan, remember that virtual options are essential,” she says.
“The needs across generations have notable similarities and differences. Our members have vastly different life experiences and very different expectations of the workplace, including their benefits plans,” Adams adds. “Successful benefits plans provide value to members of all ages.”
