Editor’s Note:Chris Goguen, Manager of Pharmacy Benefit Strategy for Medavie Blue Cross, took a deep dive into the major drug therapeutic categories that are impacting plans to uncover important trends and valuable insights for our stakeholders. This in-depth look at the data analytics and actionable insights is a must read. We invite advisors to share Chris’s key findings and recommendations with their clients for optimal plan management. We also encourage advisors and their clients to check out this Benefits Canada article in which Chris explains how leveraging data analytics and insights can drive smart, strategic decisions around their benefit plan offerings.
Targeted, high cost specialty medications will continue to drive new plan spending for the treatment of both common and rarer health conditions.
Trend: Specialty drugs (defined as drugs that cost $10K per person per year or more) continue to account for a greater proportion of the total drug bill increasing to 31% of spending in 2018 – yet representing less than 2% of drug claimants.
Trend: Expect innovative formulary management strategies to include performance monitoring and risk share programs to ensure plan value.
In the case of biologic drugs, one size does not fit all.
Trend: The fastest growing biologic drugs per capita in 2018 were Stelara, Consentyx, Entyvio and Xeljanz, representing the majority of new biologic starts and switches.
Recommendation: Consider plan management options that not only reduce costs, but also enable, even accelerate member access to the best treatment option(s) to control their disease.
Cancer care has entered the workplace.
Trend: Cancer drug expenditures rose from 6th to 5th place, contributing to 5% of overall drug spend.
Observation: New oral treatments for cancers affecting working age populations are changing the role of “private payers”, particularly in Eastern Canada.
Recommendation: Establish collaborative case management across sectors to manage the cost, complexities and coordination of cancer care.
Mental health is the single largest challenge facing organizations today.
Trend: ADHD drug expenditures cracked the Top 10 for the first time, rising to #9 in overall drug spending in 2018, with a per capita growth rate of 8.5%.
Recommendation: Consider how all aspects of the health plan (drugs, Extended Health Care benefits, Employee Assistance Programs) can be leveraged and integrated with enhanced services, technology and analytics to have meaningful impact.
The health and economic consequences of diabetes cannot be ignored.
Trend: In 2018, spending on diabetes drugs (oral medications & insulins used to control blood sugar) increased to over 8% of all drug costs, with the cost per capita growing by close to 9%, driven by the double barrel effect of increased utilization and inflation.
Recommendation: Improve health plan ROI by increasing member awareness of disease prevention and access to self-management resources like health coaching.
Connect with us: With over 75 years in the health insurance business and teams of in-house experts like Chris, we have lots of valuable information to share. Talk to your account executive to help you get the most out of your benefit plan.