What is on the horizon for health care costs?

While we are aware of the economic impact of the pandemic, it is also important to look to the future to see how the pandemic will continue to drive costs, especially on a company’s employee group benefit plan.

According to the Telus Health Drug Pipeline Report, Health Canada is reviewing a number of pharmaceuticals, not all of which are vaccines, designed for the prevention and treatment of COVID-19. Unlike vaccines, these may prove to be a private cost component for employee group benefit plans.

Three of the new drugs could significantly impact drug plans: one is a new option for acute migraine, which affects more than three million Canadians and has not seen an advance in treatment in almost 30 years. The other two treat rare diseases: one for spinal muscular atrophy and the other for cystic fibrosis. While their patient populations are very small…

MP Benefits Insights on these new drugs

Other drug treatments to be aware of include Migraine medications. In the last few years, we’ve seen effective Botox treatment for those who suffer from headaches, moving Botox from the cosmetic department to the pharmacy. A new recruit to the front-line fighting arsenal for suffers is Reyvow, from Eli Lily. The cost per tablet presently runs around $80 USD.

If approved, a ground-breaking therapy for those impacted by the rare genetic disease of Spinal Muscular Atrophy is Evrysdi. The average annual cost for treatment runs between $100,000-$340,000 USD at present, where approved.

The new drug Trikafta has been termed a “game changer” according to the Drug Pipeline report for the treatment of Cystic Fibrosis. Heralded as being able to treat up to 90% of patients afflicted, while others are limited to 10% or less due to genetic mutation, this drug may cost anywhere from $311,000 USD annually.

For those afflicted with certain genetic conditions causing cholesterol disorders or heart disease, Leqvio is under review. If approved, this will be the first in a new category where treatment will be limited to a twice a year injection. 

Multiple Sclerosis impacts about 77,000 Canadians. Just approved Kesimpta will run between $33,000-$35,000 the first year of treatment, then about $28,000 annually. As MS medications typically rank around eight for top ten drug treatments, this biologic is sure to impact experience reports.

Other pharmaceutics of note, include treatments for Wilson Disease, Dayvigo for insomnia, early Alzheimer’s Disease, Hemophilia, Dravet Syndrome. 

Health care costs in more ways than the just bottom line

Many of these new treatments are listed in the “rare” disease category where their impact will be limited to few plans. Other’s for migraines, and Multiple Sclerosis may be more readily seen as more people are often impacted. While coverage for these treatments will hit a company’s bottom line through claims, part of the consulting strategy includes ensuring plans have effective Stop Loss coverage, understanding the benefits of the non-taxable advantage of the plan. These kinds of conversations will be identifying the quality of life measures for those impacted, their ability to remain in the workforce being a productive contributor to the bottom line of the corporation, and not filing a disability claim.

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