Benefits

TELUS Health Report 2023

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P. 48 On the one hand, 2022 may be described as a "breather" year for private drug plans in some regions, due largely to the mitigating impact of biosimilar drugs on the growth in spending. Their dampening effect will continue in 2023 and 2024 as additional provinces and territories roll out their biosimilar switching policies for public plans, prompting some private payors to adopt similar policies. As well, reference biologics for a broader range of conditions will see their patents expire in the near future, paving the way for more biosimilars and expanded switching policies. On the other hand, several findings from this year's report suggest that 2022, and perhaps 2023, may be the calm before a storm. Perhaps foremost, private drug plans have yet to experience the full impact of the COVID-19 pandemic. While the number of insureds making claims appears to be rebounding, Canada's backlogged healthcare system means it may take several more years before plan members catch up with medical appointments, diagnostic tests and surgery. During that time, chronic diseases and serious illnesses, including cancer, may remain undetected or worsen more than they would have in the absence of a pandemic. For plan members already diagnosed with diabetes, spending will continue to rise, buoyed by real-world evidence of the clinical benefits of certain higher-cost therapies for both diabetes management and weight loss. Finally, the drug pipeline is becoming increasingly specialized, providing treatment options that are ever-more targeted for conditions affecting larger patient populations, or first-ever treatments for very rare diseases. Many of the latter therapies will fall into the ultra-high range in terms of cost, exceeding $100,000 per treatment or annually. However, perhaps more attention will need to be paid to what's coming for common conditions. As demonstrated by the diabetes category, new drugs that fall well below the $10,000 threshold of a specialty drug can still have a profound impact on drug spending. TELUS Health remains committed and prepared to deliver actionable information to plan sponsors, their providers and advisors on the key areas and drivers of change in cost and utilization, as well as the impact of cost-management measures.

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