Survey Reveals How Employers View Drug Plans in Canada
Benefits Canada’s first-ever Drug Plan Opinion Survey offers a revealing snapshot of how plan sponsors and advisors view today’s prescription drug plans. The results show strong confidence in the value and performance of prescription drug plans — even as employers face growing pressures to cover costly drugs for chronic conditions while keeping plans affordable.
To explore the survey’s full findings and insights, view the report.
Top concerns
While sponsors rate their plans highly, plan sponsors biggest concerns include:
- Rising costs from high-cost specialty and biologic drugs
- Increases in claims
- The challenge of balancing sustainability with protecting employee health
Expert insight
Marie-Hélène Dugal, National Pharmacy Strategy Lead for Medavie Blue Cross, served on the survey’s Advisory Board. She noted that GLP-1 drugs for diabetes and weight management, are an “area of great concern” for their impact on plans and the varied responses from payors.
“I think GLP-1s were a bit of a perfect storm, with cost on one hand and employee demand, satisfaction and feedback on the other. As we were working through implementing ways to manage access, we had some advisors asking us to mandate certain measures and others who wanted plan sponsors to remain in the driver’s seat and have the flexibility to determine criteria. There is no one right answer, and it was a complex decision for many of our clients.”
— Marie-Hélène Dugal, National Pharmacy Strategy Lead, Medavie Blue Cross
Conducted in July 2025, the survey asked plan sponsors and advisors about:
- the purpose of their drug plan
- how they evaluate it
- how decisions are made
- how well they understand their plan
- the challenges they face
Here’s what they had to say:
Plan importance
92% said their prescription drug plan was extremely or very important in today’s economic environment, with 8% calling it somewhat important.
Top reasons included:
- protecting employees from high health costs (84%)
- attracting and keeping employees (80%)
- contributing to the organization’s broader health strategy (75%)
- helping employees manage chronic conditions or chronic pain (72%)
- supporting day-to-day productivity (47%)
Half of plan sponsors said their drug plan has a big impact on productivity, talent attraction, retention and reducing absences.
Plan importance
92% said their prescription drug plan was extremely or very important in today’s economic environment, with 8% calling it somewhat important.
Top reasons included:
- protecting employees from high health costs (84%)
- attracting and keeping employees (80%)
- contributing to the organization’s broader health strategy (75%)
- helping employees manage chronic conditions or chronic pain (72%)
- supporting day-to-day productivity (47%)
Half of plan sponsors said their drug plan has a big impact on productivity, talent attraction, retention and reducing absences.
Plan satisfaction
The vast majority of plan sponsors are satisfied with their plans.
- 94% rated their prescription drug plan as excellent (30%), or good (64%).
Plan evaluation
On average, plan sponsors review their drug plan every 1.7 years.
- The most common measures of success are:
- cost (81%)
- utilization rates (77%)
- 34% said supporting the health of plan members plays a greater role in their decision-making.
- 21% prioritized controlling costs
- 48% of advisors who saw cost containment as the biggest factor
- 45% of plan sponsors said they weigh cost and health equally
Plan prioritization
When making decisions about the overall benefits plan:
- 48% felt the drug plan is the most important element (89% placed it in the top three)
- 17% prioritized mental health coverage (47% in the top three)
- 15% cited short- and long-term disability coverage as a key factor (36% in the top three)
Plan maximums
To help manage costs:
- 21% of plan sponsors reported having an annual maximum for their drug plan
- 7% had a lifetime coverage maximum
Among those with annual maximums, the average was $14,967.
Plan measures
Mandatory generic substitution was the most common cost-containment measure, used by 79% of plan sponsors.
- 64% had prior authorization requirements
- 64% applied limits to categories such as fertility, erectile dysfunction or chronic weight-management drugs
- 60% had stop-loss or pooling insurance
- 48% used per-prescription co-pays
- 47% had annual deductibles and/or co-pays
Claims analysis
- 95% of plan sponsors receive claims analysis from their insurer, plan provider or benefits advisor
- 58% get data regularly
- 20% received it occasionally
Of those who received analyses, 84% use data to identify disease trends within their workforce and better understand plan use.
Plan measures
Mandatory generic substitution was the most common cost-containment measure, used by 79% of plan sponsors.
- 64% had prior authorization requirements
- 64% applied limits to categories such as fertility, erectile dysfunction or chronic weight-management drugs
- 60% had stop-loss or pooling insurance
- 48% used per-prescription co-pays
- 47% had annual deductibles and/or co-pays
Claims analysis
- 95% of plan sponsors receive claims analysis from their insurer, plan provider or benefits advisor
- 58% get data regularly
- 20% received it occasionally
Of those who received analyses, 84% use data to identify disease trends within their workforce and better understand plan use.
Information sources
To stay current on prescription drugs and issues affecting their plans, plan sponsors rely on:
- their benefits advisor (91%)
- their insurance company (58%)
- industry media (45%)
- conferences (42%)
- industry associations (30%)
Health outcomes
The survey revealed that knowledge gaps remain:
- Only 11% of sponsors feel very knowledgeable about health outcomes resulting from their drug plan.
- 54% said they were somewhat knowledgeable
- 35% said they were not knowledgeable
Yet most believe that decisions to cover or not cover a drug, affect member and family health.
- 47% said these decisions have an extreme impact
- 30% said somewhat of an impact
- 7% said little to no impact
Cost drivers
- 83% of plan sponsors and 90% of advisors said drug plan costs (including claims, premiums and pooling) have risen over the past three years.
- 24% of sponsors and 17% of advisors reported significant increases.
Plan sponsors attributed rising costs to:
- higher drug prices (88%)
- growing claims for biologic and high-cost specialty medicines (71%)
- inflation (57%)
- a general rise in claims (48%)
Advisors were more likely to point to:
- increases in biologic and specialty drug claims (90%)
- higher overall drug costs (71%)
- increases in stop-loss or pooling insurance (62%)
- general increases in claims (53%)
Specialty drugs
- 20% of plan sponsors changed coverage for weight-management drugs based on member requests
- 21% cannot make changes due to factors such as union agreements
When deciding on coverage for drugs related to weight loss, sexual dysfunction, fertility, smoking cessation, and vaccines:
- 43% said member health was the top consideration
- 32% prioritized controlling costs
- 25% weighed both equally
The report concludes that more education and stronger collaboration across the industry could help plan sponsors strike the right balance between cost control and health.
Specialty drugs
- 20% of plan sponsors changed coverage for weight-management drugs based on member requests
- 21% cannot make changes due to factors such as union agreements
When deciding on coverage for drugs related to weight loss, sexual dysfunction, fertility, smoking cessation, and vaccines:
- 43% said member health was the top consideration
- 32% prioritized controlling costs
- 25% weighed both equally
The report concludes that more education and stronger collaboration across the industry could help plan sponsors strike the right balance between cost control and health.
How Medavie Blue Cross helps employers build sustainable drug plans
Medavie Blue Cross is taking a new approach to addressing obesity — one based on medical evidence and focused on results, while keeping plans sustainable. In April 2025, we updated our criteria to match Canadian guidelines and now require ongoing reassessments to confirm medications are working. Learn more about our approach to weight management:
For more information on our programs to manage obesity and other chronic conditions, connect with your Medavie Blue Cross representative.
Posted by Medavie Blue Cross on January 13, 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...