The majority (85 per cent) of Canadian plan members used their drug plan at least once in the past year, according to the 2018 Sanofi Canada health-care survey.
Among plan members who submitted drug claims, the average number per year was 9.4. That figure rose to 14.5 claims for both employees in poor health and those who take three or more medications. For plan members with at least one chronic disease, the average number of claims per year was 10.9.
The survey also found the amount plan members estimated they paid for drugs and what the plan actually spent on average was out of sync. Plan members estimated their drug plan spent $1,757 on themselves and $2,009 on their family. In fact, the average overall combined drug plan spend for those submitting at least one claim was $2,298.
Plan members weren’t overly confident that their drug plan would cover high-cost drugs. For example, 53 per cent of respondents felt confident their benefits plan would cover a medication that cost $60,000 per year.
About a third (31 per cent) of plan sponsors in Quebec said they faced pressure from senior management to cut costs, compared with 12 per cent of those in Ontario and 26 per cent of public sector employers across all provinces.
As well, 17 per cent of plan sponsors said their drug plans have annual maximums, with 27 per cent saying they weren’t aware if their plan had a cap or not. Drug plan caps are also more prevalent among plan sponsors that offer health-care spending accounts, at 24 per cent, compared to those without such an offering (14 per cent).
“Small-business employers either pay too little attention to their benefit plan or they go they opposite route and hit the panic button,” said Dave Patriarche, president of Mainstay Insurance Brokerage Inc. and one of the survey’s advisory board members.
“Some put in drug caps or HSA-only plans, usually on the advice of brokers who walk in with data that creates fear about higher-cost drugs — even though higher-cost drugs are why we need insurance. We need better tools to educate clients and ourselves on the value of insurance.”
Read more articles from the 2018 Sanofi Canada health-care survey