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Which health conditions are impacting benefits plans?

Published by Benefits Canada on September 15, 2019

The Health Association of Nova Scotia, which has a number of different employers in its benefits plan, cites rheumatoid arthritis medications as its top drugs in terms of cost.

“Chronic disease, in terms of inflammatory disease — not just for rheumatoid, but for Crohn’s disease as well — those are what we’re seeing from a cost perspective,” says Susan Belmore-Vermes, the association’s director of group benefits solutions.

Diabetes is another top area of concern, she adds. And, since Nova Scotia has high rates of cancer, oncology drug use continues to climb in the province and is certainly impacting benefits plans.

Read: Data key in helping employees with chronic disease, survey finds

So with drug costs continuing to affect benefits plan sustainability, which health conditions — and their associated medications — should plan sponsors be looking out for?

Chronic diseases as growth drivers

The Health Association of Nova Scotia’s experience is on par with other Canadian plan sponsors, according to many in the industry.

John Herbert, director of business development and clinical services at Express Scripts Canada, points to the growth of speciality medications, which currently make up more than 30 per cent of drug spend. A big component of that spend is for inflammatory conditions, he notes, referring particularly to Remicade, which is used to treat certain types of arthritis and inflammatory bowel disease.

Chris Goguen, manager of pharmacy benefits strategy at Medavie Blue Cross, says diabetes is the No. 1 growth driver in terms of overall impact. “We’re seeing that it’s both a factor of increase and utilization, so growth and prevalence of those being treated for diabetes — largely type 2 — but also inflationary pressures, and more individuals being treated are being treated with more medicines and more expensive medicines.”

Read: A call for more solutions to address the growing diabetes burden

Drug trends at a glance

The average annual drug spend per plan member was up just 0.9% in 2018, down from 2.5% in 2017 and 2.9% in 2016.

Specialty drug spending surged, from 15% of total spend in 2008 to 33% in 2018.

Patients with chronic conditions had high levels of nonadherence, including 70% of plan members with asthma, 47% with cancer, 45% with diabetes and 45% with inflammatory conditions.

Source: Express Scripts Canada, 2019

In 2018, the insurer’s diabetes expenditure increased on a per capita basis by almost nine per cent, making it the leading growth driver as a percentage, according to Goguen.

Suzi Beckett, chief operating officer and health and benefits consultant at Northern Star Benefit Consultants Ltd. in Surrey, B.C., also says diabetes is leading the pack among group claims, followed by rheumatoid arthritis, in terms of drug use cost. “So it’s a significant price tag, but not high volume that leads to the cost.”

Specialty drugs used to treat severe and catastrophic conditions represented between 29 and 33 per cent of plan sponsors’ overall drug claim spend in 2018, she says. “Plan design and provincial coverage notwithstanding, demographics play a key role in health-care utilization. Many of our clients whose policy reflects an older demographic are experiencing sustained drug plan utilization ranging from 70 per cent to 85 per cent.”

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Express Scripts Canada