What the latest drug utilization trends can tell plan sponsors

The latest utilization trends for drug plans, O’Brien says, add to concerns about a possible brewing “shadow pandemic” of illnesses. After countless Canadians were forced to put off or cancel appointments for in-person screenings, the healthcare system is now working through a backlog of cancer diagnostic tests. A similar situation is developing in cases where people were unable to access mental health services and treatments.

He also points to drug-supply policies put into effect during the early months of the pandemic in most provinces, which led to more refills on prescriptions for chronic conditions, as prescriptions were limited to a 30-days supply to guard against shortages and/or stockpiling.

“We will likely see delayed adverse effects from the pandemic on the health insurance industry, which is important for insurers and employers to remain aware of as they prepare for upcoming years,” O’Brien says.

Even though fewer insureds made claims last year, the eligible amount spread out across claimants rose. Data from the past two years show the growth rate for eligible amount per claim in drug plans was significantly above inflation, as measured by the CPI, which includes the record highs seen in the later months of 2021.

Looking ahead, O’Brien encourages plan sponsors to regularly monitor plan performance to get a bead on cost drivers and risks, which can guide decisions on where plan design may need to change, as well as where communications with plan members may need to be focused. The ability to review data on adoption of specific plan design solutions, he adds, may help guide sponsors on where changes need to be focused to help ensure the future sustainability of benefit programs.