Did you know that 25% of all drug spend in employee benefits plans is on diabetes, inflammatory conditions, and depression? We’ve been keeping our eye out for some of the latest drug claim trends and have seen some interesting numbers come out in the last few months.
When looking at the breakdown of drug claims in an employee benefits plan, it’s important to understand that there are two main categories of drugs: traditional and specialty. Traditional drugs are defined as any drug that has an annual cost under $10,000. On the other hand, specialty drugs are attributed to any spend that is over $10,000 annually. The fastest growing traditional drug categories are currently diabetes and ADHD. On the other end of the spectrum, the top specialty drug categories include arthritis, crones, psoriasis, cystic fibrosis, atopic dermatitis, and asthma.
Here are a few insights into the latest drug claim trends for you to be aware of.
1. Depression and ADHD drug claim trends
Depression has consistently been within the top five therapeutic classes since 2012. As such, the percentage of claims related to antidepressants has been steady year over year. Moreover, awareness around mental health on the rise, especially in the years following the pandemic. Therefore it comes as no surprise that these numbers have remained so prevalent and consistent.
When you dig into the data of drug claim trends, you get an even clearer picture of what’s happening. The 45 to 54 year age group has the most claimants for depression. This demographic generally represents the average age of the workforce in Canada. On top of this, doctors prescribe antidepressants not just for depression but to address a variety of other conditions. These include chronic pain or ADHD. In fact, ADHD is significantly on the rise. We recently completed a top drug report for a client and number 3 on the list was for claims to treat ADHD.
The average diabetes spend per claimant is now around $1,100 per year. And, according to latest drug claim trends, 12% of all drug claims across Canada are for diabetes. That percentage is quite high. Cases of diabetes are certainly high in Canada. This in turn contributes to higher numbers of drug claims for diabetes. However there is one drug in particular that might be behind these rising numbers: Ozempic. It’s possible you’ve heard its name in the news lately because some opt to use it for weight loss. As such, we’re seeing insurance carriers quickly respond to this trend.
For example, one carrier has addressed the popularity of Ozempic by stating if it has not been prescribed for diabetes, they simply will not pay for it. This means that there has to be a doctor’s diagnosis of diabetes for an employee to be eligible to make a claim and receive benefits to cover the cost of Ozempic. Keep in mind this is just one example of parameters a carrier put in place. Therefore it’s important to look at your own plan and be aware of how your carriers is managing diabetes claims.
3. Anti-Inflammatory & Other Specialty Drug Claim Trends
We’ve seen a lot of drug claims more recently related to gastrointestinal issues and a whole series of stomach issues. Claims for anti-inflammatory drugs are of note because this can include a pretty broad range of symptoms. Anything from chronic pain to acid reflux and bloating can fall under this general category of gastrointestinal issues.
The good news is that there are limits on drug spend that are usually set by your insurance carrier. However, as an employee benefits plan administrator, it’s still important to keep a pulse on specialty drug claim trends. That is becasue specialty drugs come with a high price tag. For example, the annual cost of a new drug for cystic fibrosis is $300,000 per year per claimant! We’re also seeing a new trend with many cancer drugs moving from injectable to oral. Injectable drugs were traditionally administered in a hospital and therefore covered by the province. However, oral capsules are typically purchased at a pharmacy, so they are a private cost that a group plan would cover. This is a good example of costs shifting from public to private, which ultimately impacts your employee benefits plan.
Another drug claim trend to look out for in the coming year is the rise of biosimilars. Stay tuned for our next post to get details on this emerging drug category, and to get a refresher on everything you need to know about the Saskatchewan Drug Plan.
Are you interested in looking at drug claim trends in your own employee benefits plan? Get in touch with us today to request a report.