Attention deficit hyperactivity disorder is commonly misunderstood and can reduce the ability of a person to function while impacting their quality of life, said Anjila Arora, director of pharmaceutical benefits at Sun Life Financial Inc., during a session at Benefits Canada’s 2022 Face to Face Drug Plan Management Forum in Toronto in December.
Although ADHD is commonly perceived as a disorder that affects children and adolescents, it’s also prevalent in the working age population, she said, referring to research that found most employers named ADHD among the top five mental-health conditions reported among employees, in fourth position along with alcohol addiction.
While the cause of ADHD remains unclear, the general prevalence is estimated to be between three and nine per cent for children and three and five per cent for adults. It’s a neuro-developmental disorder where symptoms typically appear in childhood and often continue into adulthood.
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“Adults with ADHD may be easily distracted, struggling with mental restlessness, disorganization and procrastination,” said Arora. “They may have difficulty beginning and completing tasks, managing time and controlling behaviours and impulses and managing their emotions.”
ADHD can profoundly affect personal and work lives, leading to a chronic sense of underachievement and low self-esteem, she said, noting adults suffering from ADHD have higher absenteeism and lower productivity. In addition, they often channel their physical restlessness into work or sport activities, with some even self-medicating with stimulants or illicit drugs. Over the course of time, hyperactivity and impulsivity may reduce, noted Arora, with people growing out of these symptoms; however, inattention doesn’t usually change as people age.
According to Sun Life data, ADHD drug claims increased by 67 per cent between the first quarter of 2018 and the fourth quarter of 2021, while the growth in overall mental-health drug claims for the same period was 28 per cent. This was driven by the growth in the number of claimants taking these drugs, which increased 15 per cent between 2020 and 2021. Although claims for those 15 years and younger represent the majority of ADHD claimants, people between the ages of 15 and 45 saw the largest increase in claimants.
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Several ADHD drugs with the most claimants ranked lower in terms of the amount paid, likely due to the availability of generic options, said Arora, noting several generics are expected in the coming years that could have an impact on ADHD drug spend. “From a drug management perspective, having mandatory generic substitution can be an important tool for savings and promoting plan sustainability.”
ADHD lends itself to a holistic approach for management, she said, referring to the Canadian ADHD practice guidelines that emphasize the importance of a comprehensive, collaborative and multimodal approach that incorporates psychosocial interventions with medications and is tailored to meet the unique needs of each individual. This approach “can not only improve core ADHD symptoms, but overall quality of life by improving functional impairments,” she added.
An analysis of Sun Life claims indicated that a minority of claimants for ADHD drugs are actually tapping into their paramedical mental-health practitioners for support. “While we have seen an increase from 2019 to 2021, only 28 per cent of claimants for ADHD drugs also consulted a practitioner,” said Arora.
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Plan sponsors can play a key role in supporting their members’ treatment through their workplace benefits programs, she said, noting they can educate and empower those living with ADHD by providing information about how it can impact their daily functioning, as well as treatment options and strategies. She also suggested plan sponsors demystify societal myths commonly associated with ADHD through their workplace wellness strategies, offer workplace accommodations for those living with ADHD and provide coverage for necessary psychosocial interventions.
Ultimately, ADHD can profoundly affect employees lives and contribute to higher absenteeism and lower productivity in the workplace setting, said Arora. “It’s an important condition for employers to consider as part of the broader conversation and holistic approach to mental health.”
Read more coverage of the 2022 Face to Face Drug Plan Management Forum.