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Diabetes Medications Lead Canadian Private Insurance Claims

April 25, 2024 from HRD Canada

In Canada, the landscape of drug claims continues to evolve, with diabetes medications prominently leading the way. A recent report by TELUS Health reveals that in 2023, diabetes medications accounted for 15.4% of all eligible private insurance claims, marking them as the most claimed category above others such as inflammatory diseases, skin disorders, ADHD, and depression.


The dominance of diabetes medications in insurance claims is tied to the increasing prevalence of type 2 diabetes across the nation. Vicky Lee, manager of pharmacy consulting at TELUS Health, notes, “The steady growth reflects the higher prevalence of type 2 diabetes year after year.” Lee also highlights the role of second- and third-line therapies, which have shown effective results, and their off-label use for weight management as significant factors contributing to this trend.


Statistics from Health Canada support this observation, indicating that over three million Canadians, or 8.9% of the population, are diagnosed with diabetes. The condition has seen a yearly prevalence increase of 3.3%. The expanding applications of diabetes medications, including for heart failure treatments and weight loss, have led to a remarkable 29.4% increase in claim amounts over the previous year.


Financially, the impact is substantial. The average annual eligible amount per certificate was $1,262 in 2023, with each certificate claiming an average of 15.1 times at $83.53 per claim. These top 10 categories together constituted 62.2% of all claims.

Employers are bracing for a 5.2% increase in the average per-employee cost of health insurance in 2024, as per a Mercer report, underscoring the rising expenses tied to healthcare benefits. Growth rates in total eligible amounts have been robust, with more than a 20% increase in the last three years and consistently high growth in almost all of the past 16 years.


Looking ahead, TELUS Health anticipates that alongside diabetes, categories such as ADHD, depression, weight management, and women’s health will be critical areas to monitor due to their expected impacts on drug-plan expenditures as well as on personal health and productivity. The shift in prescribing behaviors, influenced by new clinical guidelines recommending more aggressive initial treatments, is also expected to play a pivotal role in shaping the future landscape of drug claims in Canada.


For employers and healthcare providers, understanding these trends is essential for managing future health benefits plans effectively, ensuring that they align with the evolving healthcare needs of Canadians.




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