More than ever before, data drives smart business decisions. Our resident subject matter experts, Anne-Marie Smith, Pharmacy Consultant, and Colleen Adams, Manager, Health and Digital Product Solutions turned data analytics into valuable insights health and shared them at our second Insights webinar of 2022. This is the first in a two-part series that highlights the numbers you need to drive your plans with data.*
Total Health Spending
In 2021, 65% of total claim spend was on drugs and 35% was on Extended Healthcare Benefit Claims (EHC). This 65/35 split remains very stable and is nearly identical to the split five years ago. We expect the trend to continue.
Biologics for autoimmune conditions represents 12.9% of total health spend and has an average cost per claimant of $20,000. This stretches across people aged 25–75. After 75, biologics gets pushed out by drugs for cardiac and diabetes. The trend is attributed to utilization (more members being diagnosed and treated for autoimmune conditions).
Biologics, diabetes and cardiac are the top three therapeutic categories by dollars paid. Biologics and diabetes also highest trend drivers, followed by ADD/ADHD and antidepressants.
The percentage being spent on specialty drugs is slowly increasing each year. Not only is the drug pipeline filled with new specialty drugs for rare conditions, cancer, or the autoimmune conditions, but there are also specialty drugs for chronic conditions such as asthma, cholesterol and severe eczema, just to name a few.
“Keeping drug plans sustainable and affordable is a key priority for Medavie Blue Cross. Our drug management solutions program is designed to strike the right balance between member access to effective treatment and sustainable cost for their plan. “- Anne-Marie Smith
At the centre of Drug Management Solutions is our Medication Advisory Panel, which takes an expert look at the health and cost implications of every drug considered for inclusion on our formulary.
Rxperience is a comprehensive, cost-effective solution designed to give plan sponsors an opportunity to offer competitive and sustainable health benefits to their valued employees. Rxperience offers broader drug coverage, open access to traditional drug benefits and specialty drug management, with less administration and more cost-savings.
It’s a plan that focuses on member care and cost management tools such as prior authorization for high-cost specialty drugs, mandatory generic substitution for multi-source brand drugs, and an opioid management strategy for responsible drug utilization.
“Diabetes is a rapidly growing, complex medical condition both in Canada and around the world. From less than 4% of the Canadian population in 2000, the incidence has more than doubled in only two decades. By 2021, 8.8% of Canadians had been diagnosed with diabetes with another 6.1% at high risk for developing this lifelong condition.” - Colleen Adams
One in 15 members covered under Medavie Blue Cross has diabetes, making it the #2 trend driver of growth for all private plan expenditures.
The overall cost per claimant with diabetes was $1,296 in 2021.
We saw a 13.6% increase in cost per capita.
The top diabetes drug contributing to the trend is OZEMPIC®, a drug that is injected once a week for type 2 diabetes, at a cost of around $2,500 per year, and is generally added on to other therapies.
Type 2 diabetes represents 90% of diabetes diagnoses and is linked to aging, obesity, and sedentary lifestyles, all of which are on the rise.
Claimants with diabetes typically have a higher cost per claimant compared to non-diabetes claimants. In addition, they generally are at a higher risk for comorbidities such as cardiac, high cholesterol and gastrointestinal problems.
Other Chronic Conditions
18.8% members claimed for cardiovascular disease at average cost of $308.
7.9% members claimed for respiratory disorders at an average cost of $390.
23% of the plan member population is now claiming for cardiac drugs.
The first of its kind in Canada, this EHC benefit connects plan members with accredited health professionals in their communities for one-on-one coaching and education services to help them take charge of their condition and improve their quality of life. The benefit offers expert supports to self-manage asthma, COPD, diabetes, hypertension and to quit smoking.
This digital health solution integrates personalized coaching, home delivery of test strips and glucose monitoring to support plan members living with diabetes, pre-diabetes, high blood pressure and/or high cholesterol.
*Note: The data is based on analysis of claims spending in 2021 covering about 1.4 million group and private plan members.
Want to learn more about our claims trends and targeted solutions?
Watch the webinar to hear the entire discussion, hosted by James Deware, Manager, Group Brokerage Sales, and connect with your Medavie Blue Cross representative to find out how our solutions can work for you.
For over 75 years, Medavie Blue Cross has been a leading health services partner for individuals, employers and governments across Canada. As the country’s leading Blue Cross plan with over one million card holders, we are a premier all-in-one carrier that provides health, dental, travel, life and disability benefits to...