Specialty Drugs and Plan Sustainability

Where are we on the increase cost of drugs in Canada?


This whole issue has sort of crept up on Group Benefit Plan providers.
Since 2013 the use of Specialty drugs have changed. Before 2013 Specialty drugs were seen more as experimental drugs.
Now they make up 20% of the drug costs in Canada while traditional drugs have actually gone down by 1%. Meanwhile the actual number of plan members these drugs help amount to .7% of the entire insured population.

Almost 60% of new drugs approved in Canada have been Specialty drugs. Currently for example there are 218 new Cancer and immune drugs about to be approved. There are 58 Phase 3 or above and 160 ready to approve.

What Specialty Drugs mean to Plan Sponsors


When a Plan Sponsor looks at their top 50 drugs claimed by amount spent, they will probably see Humira, Harvoni or Remicade on their list. Harvoni has gone from paid claims in 2014 of $3 million dollars to $42 million in 2015.

Plan Sponsors have to come to the terms with alternatives. The easiest is if your plan does not currently have a large claimant then apply an annual spend on drugs of $5,000 to control the cost.
Yes, this may eventually affect some of your members but it protects your plan from becoming unaffordable and the pooling charges going out of control.

Talk to us about your options.