During the same period, cost growth for all drugs covered by plans was 7.5%, meaning that much of the growth in prescription drug spending came from expensive specialty drugs. .
Over the past few decades, the total amount of pharmaceutical benefits paid to the ten largest claimants at Beneva has increased 25-fold. While such a trend poses significant challenges for group insurance plans, the insurer emphasizes that it represents also a major advance for individuals with rare diseases, who now have access to treatment options that greatly improve their quality of life.
Furthermore, Beneva has noted a strong growth in claims for the treatment of obesity since Wegovy’s arrival in Canada last May.
To better control costs, the insurer reiterates the importance of prior authorization programs, fraud prevention measures and the mandatory transition to biosimilar drugs.
Migraine, ADHD and dental care
Benefit plan sponsors should also keep an eye on advances in preventive treatments for migraine, the bulletin says. New medications make it possible to reduce the frequency of episodes and the costs of emergency treatments. These new molecules may, however, prove more expensive, leading to an increase in the average amount of reimbursement requests per insured person.
In the short term, the additional costs associated with these medications could require adjustments to premiums and contributions, while in the longer term, insurers will need to ensure they evaluate the effectiveness of these treatments compared to existing options, particularly in terms of reducing absences and improving quality of life.
Another recent trend: adults are now the main consumers of medications for attention deficit disorder with or without hyperactivity. On the one hand, Canadians diagnosed in their youth are reaching adulthood, and on the other hand, more and more parents are being diagnosed at the same time as their children.
Finally, while the gap between the increase in dental care costs recommended by provincial rate guides and the purchasing power of Canadians has widened in recent years, Beneva suggests showing more flexibility in the plans by implementing more personalized protection options according to the needs and budgets of participants.
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