As the drug plan landscape evolves, the nuanced tension between cost management and the imperative to support employee health continues, according to a panel of experts discussing Benefits Canada’s inaugural Drug Plan Opinion Survey during the 2025 Face to Face Drug Plan Management Forum.
The survey, which polled 124 Canadian plan sponsors with at least 100 employees and 67 benefits plan advisors with at least 10 group benefits clients, found drug plans remain a significant workplace benefits offering, with nearly 92 per cent saying their prescription drug plan was extremely or very important.
This finding was further emphasized by the plan’s role in protecting employees against undue financial burden due to health needs (84 per cent) and its impact on attraction and retention (80 per cent). As well, the survey found plan sponsors most commonly use cost (81 per cent) and utilization rates (77 per cent) to evaluate the success of their drug plans.
Download Benefits Canada‘s inaugural Drug Plan Opinion Survey here.
Indeed, cost pressures remain a central concern, said Elena Shiganova (pictured middle left), senior manager of total rewards at the City of Mississauga. “Slightly less than five per cent of drug claims are responsible for 40 per cent of our cost. These are high-cost claims such as biologics and cancer treatments,” she added, noting the City spends 23 per cent of its benefits plan costs on drugs.
“Analyzing cost is something that organizations understand,” said Frédéric Leblanc (pictured left), strategic leader of drug programs, group benefits and retirement solutions at iA Financial Group. “However, there needs to be a shift to also look through the lens of value and health outcomes.”
As an example, he described a hike in drug plan costs due to a claimant who starts an expensive medication for cancer, but once the plan sponsor recognizes the reason for the increase, it realizes the organization is supporting a member with cancer and fulfilling the intended value of the program.
“We have a systemic challenge because health care and benefits plans are siloed and segmented,” said Anu Sharda (pictured middle right), senior director of strategic payor partnerships and growth at Shoppers Drug Mart.
Indeed, there are differences between the private payors and the public government plans, she added, noting that even within employer-sponsored benefits plans, the drug, paramedical, extended health and disability benefits are all managed separately.
“It can be challenging to see the value of a drug treatment through the ecosystem and that perhaps investing upfront can prevent and reduce disability claims downstream.”
Domenico Morrone (pictured right), senior manager of benefits at 123Dentist, also highlighted the challenge in balancing cost and value. “Cost is obviously a driving factor, but value is equally important. Neither can be considered in isolation; rather, they must be evaluated together.”
The survey also asked plan sponsors which cost-containment measures were currently part of their drug plan design. The top results were mandatory generic substitution (79 per cent) and prior authorization (64 per cent).
While these plan designs may manage costs, said Sharda, understanding these mechanisms can be challenging for plan members. She encouraged plan sponsors to consider members’ experiences of these plan designs and urged a patient-centred approach.
Download Benefits Canada‘s inaugural Drug Plan Opinion Survey here.
Read more coverage of the 2025 Face to Face Drug Plan Management Forum.