Half of Canadian plan members confident their benefits plan covers high-cost drugs: survey

Nearly half (49 per cent) of Canadian plan members said they’re confident their group benefits plan will cover medications for serious diseases such as cancer and diabetes, which cost between $1,000 and $10,000 per month, according to the 2020 Sanofi Canada health-care survey.

When presented with the scenario of a drug that can treat or even cure very rare, very serious diseases, but may cost $1 million per patient, 46 per cent of plan members said they feel the government should pay most of the cost and the workplace plan pays the remainder, while 13 per cent said they feel the government should pay all of the cost. Plan sponsors agreed, at 45 per cent and 16 per cent, respectively.

Read: Rising cost of drugs, benefits plans top priorities for employers: survey

Additionally, 22 per cent of plan members and 15 per cent of plan sponsors said they feel the group drug plan should pay most and the government the remainder. And six per cent and 13 per cent, respectively, indicated neither the government nor workplace plans should pay, as these drugs are unaffordable and it should be up to the individual to arrange payment.

The survey then presented additional scenarios to plan members. For higher-cost drugs to treat serious conditions such as cancer, 78 per cent said they believe the government should pay, followed by employers (36 per cent) and employees (11 per cent). And for drugs to treat more common serious conditions such as high cholesterol, where cost isn’t specified, 57 per cent of plan members said employers should pay, followed by the government (48 per cent) and employees (21 per cent).The survey also found 22 per cent of drug plans have an annual maximum, which is comparable to last year’s findings, at 21 per cent, and a modest increase over 2018, at 17 per cent. A quarter (24 per cent) of plan sponsors said they don’t know if their drug plan has a maximum.

The average annual maximum is $9,900, compared to $7,800 in 2019 and $4,100 in 2017, resulting in a median maximum of $2,000. However, 55 per cent of plan sponsors have a maximum under $2,500.

“I don’t think any employer envisioned a drug that costs hundreds of thousands of dollars annually on a recurring basis,” said Barb Martinez, practice leader of drug solutions at Canada Life and an advisory board member. “Our benefits plans were not designed for that. Pooling protection is an absolute must in this environment, as well as having a strong philosophy and objectives for the drug plan so that it can be designed to manage risk and share costs appropriately and sustainably.”

Read: Drug adherence an increasing issue for plan members, sponsors, finds survey