Key Insights from Medavie Blue Cross’s 2025 Trends Webinar
Drive Your Plan with Data
Key Insights from Medavie Blue Cross’s 2025 Trends Webinar
Each year, Medavie Blue Cross is among the first Canadian insurers to share a clear picture of claims data and what it means for workplace health benefits.
In our recent Drive Your Plan with Data Insights webinar, we explored 2025 claims trends and translated them into insights to help guide plan decision-making and design.
Key takeaways
- Specialty drugs: More use for common conditions; skin therapies are the fastest-growing cost driver
- Diabetes: Use is up slightly, with future savings expected from generics
- Weight management: Rapid growth, with new criteria helping control costs
- ADHD: Rising demand, with females now making up over half of claimants
- Mental health: Counselling continues to outpace drug spending
- Menopause: Hormone therapy is now a top five drug trend driver
Top trends
Chronic conditions are affecting nearly half of members
- 45% of members now claim for at least one chronic condition. This is up from 43% in 2022.
- More members are living with more than one condition:
- 55% have one
- 28% have two
- 17% have three or more (up from 15% in 2021)
This increase shows the need for prevention, early support, and ongoing care.
Top trends
Chronic conditions are affecting nearly half of members
- 45% of members now claim for at least one chronic condition. This is up from 43% in 2022.
- More members are living with more than one condition:
- 55% have one
- 28% have two
- 17% have three or more (up from 15% in 2021)
This increase shows the need for prevention, early support, and ongoing care.
Drug costs are rising more slowly, but plans are still under pressure
In 2025:
- 64% of total benefit spend went to drugs
- 36% went to extended health benefits
Overall, costs grew more slowly than last year. This was due to slower growth in specialty drugs, steadier inflation, and more stable use of services.
What’s driving extended health claims
Massage therapy remains the top category, followed by mental health practitioners, physiotherapy, glasses, diabetic supplies and chiropractic care — an order unchanged from 2025.
Mental health practitioners represent the fastest-growing category. This trend is expected to continue as maximums and use increase year over year.
What’s driving drug claims by spend:
- Inflammatory conditions
- Diabetes
- Mental health drugs
- Respiratory, cancer, cardiac, ADHD, multiple sclerosis, weight management, and gastrointestinal drugs
What’s driving drug claims by number of claims:
- Cardiac drugs are #1
- Mental health medications are #2
- Followed by diabetes, respiratory, cancer, cardiac, and gastrointestinal drugs
Top drugs by cost:
- Diabetes: Ozempic
- Inflammatory conditions:
- Remicade
- Humira
- Weight management: Wegovy
Top new drugs to market in 2024 and 2025:
- Weight management: Zepbound
- Diabetes: Awiqli
- COVID-19 vaccine: Comirnaty
- Skin conditions: Opzelura
Specialty drugs: few claims, big impact
Our Medication Advisory Panel reviewed 110 drugs for their health value and cost impact in 2025:
- 76% of all the reviews were for specialty drugs, which require prior authorization and typically cost in excess of $10,000 per year or per treatment.
Specialty drugs now make up:
- Just 1% of drug claims
- But 37% of total drug spend
This share continues to rise as specialty drugs treat more common conditions.
- Inflammatory condition drugs continue to drive specialty drug costs. This is due to newer therapies and existing drugs being approved for more conditions.
- Cancer drugs are the second most common type of specialty drug. Use is increasing due to higher diagnosis rates and more expensive therapies.
- Skin condition therapies are growing the fastest and now rank fourth among specialty categories. Their share of eligible spend jumped from 1.7% to 2.5% this year, making them a key new cost driver.
Specialty drugs: few claims, big impact
Our Medication Advisory Panel reviewed 110 drugs for their health value and cost impact in 2025:
- 76% of all the reviews were for specialty drugs, which require prior authorization and typically cost in excess of $10,000 per year or per treatment.
Specialty drugs now make up:
- Just 1% of drug claims
- But 37% of total drug spend
This share continues to rise as specialty drugs treat more common conditions.
- Inflammatory condition drugs continue to drive specialty drug costs. This is due to newer therapies and existing drugs being approved for more conditions.
- Cancer drugs are the second most common type of specialty drug. Use is increasing due to higher diagnosis rates and more expensive therapies.
- Skin condition therapies are growing the fastest and now rank fourth among specialty categories. Their share of eligible spend jumped from 1.7% to 2.5% this year, making them a key new cost driver.
Diabetes: change is coming
Diabetes represents:
- 7% of all drug claims
- 12% of total drug spend
Use dipped slightly due to tighter controls on GLP-1 therapies, but overall costs rose because of newer, higher-priced treatments.
Looking ahead, new generic versions of two major diabetes drugs are expected to lower costs. This could help improve long-term plan sustainability.
Groups are advised to have mandatory generic substitutions in place to protect against rising costs and capture savings when generics enter the market.
More information:
Weight management: fast growth, new controls
Weight management drugs are one of the fastest-growing categories, driven by new treatments, medical need, and public awareness.
Even so, they still account for:
- Less than 1% of drug claims
- About 3% of total drug spend
New prior authorization criteria are helping to steady costs and support member health outcomes. Ongoing plan management will be important as demand rises.
Weight management: fast growth, new controls
Weight management drugs are one of the fastest-growing categories, driven by new treatments, medical need, and public awareness.
Even so, they still account for:
- Less than 1% of drug claims
- About 3% of total drug spend
New prior authorization criteria are helping to steady costs and support member health outcomes. Ongoing plan management will be important as demand rises.
For the best outcomes, we recommend covering weight management drugs with prior authorization and without maximums.
More information:
ADHD: changing patterns, rising use
ADHD now accounts for:
- 4% of drug claims
- 4% of total drug spend
Generics have helped lower costs, but more people are using these medications as diagnosis rates and awareness increase.
A major shift: 53% of ADHD claimants are now female. Growth is strongest among adult women aged 20-45, pointing to the need for inclusive, age-appropriate supports.
More information:
Mental health: counselling now leads
Mental health remains a top driver of claims:
- 14% of health claims
- 10% of total health spend
- Still the #1 cause of disability leave across all ages
For the second year in a row, spending on counselling passed spending on mental health drugs. Counselling costs rose another 13.5%, while drug costs stayed flat.
Nearly 13% of mental health claimants now use both medication and counselling. This shows a shift toward more complete care.
More males continue to seek practitioner support, driven in part by growth in Millennial and Gen Z groups who are more likely to use these services.
More information:
Mental health: counselling now leads
Mental health remains a top driver of claims:
- 14% of health claims
- 10% of total health spend
- Still the #1 cause of disability leave across all ages
For the second year in a row, spending on counselling passed spending on mental health drugs. Counselling costs rose another 13.5%, while drug costs stayed flat.
Nearly 13% of mental health claimants now use both medication and counselling. This shows a shift toward more complete care.
More males continue to seek practitioner support, driven in part by growth in Millennial and Gen Z groups who are more likely to use these services.
More information:
Connected Care: helping members stay healthy
This year’s claims data shows more people living with chronic conditions and ongoing pressure from changing drug costs. It also points to a growing need for easier access to coordinated care.
Connected Care brings prevention, early support, and chronic condition management into one digital platform, helping members access trusted care wherever they are.
Members can access:
- Health coaching for diabetes, blood pressure, and obesity
- Live online therapy and internet-based CBT
- ADHD assessment and treatment
- Gut Health test kit, personalized report and dietitian consultations
- Menopause assessment and coaching
- Wellness tools and preferred-price services
By making care easier to reach, Connected Care helps members stay engaged while supporting plan sustainability through earlier support and better outcomes.
Your Path to Connected Care
Discover how Connected Care helps members access healthcare services covered by our plans.
Watch the full webinar
Get the full story behind the 2025 claims trends and what they mean for your plan.
Posted by Medavie Blue Cross on March 27, 2026
Medavie Blue Cross is a premier all-in-one carrier that provides health, dental, travel, life and disability benefits and administers federal and provincial government-sponsored health programs. Together with Medavie Health Services, we are part of Medavie, a health solutions partner committed to improving the wellbeing of Canadians. We are in the...