iAtoday

By:

Erika Hatherly, Pharmacist

Strategic Leader, Drug Programs
Group Insurance

Erika Hatherly’s profile

Frédéric Leblanc, Pharmacist

Strategic Leader, Drug Programs
Group Insurance

Frédéric Leblanc’s profile

As part of the ongoing development of our drug management strategies, we rank the drugs responsible for the highest spending for all group insurance plans every year. Reviewing these top ten drugs highlights the constant evolution of pharmaceutical innovations and the resulting influence on both costs and the total wellbeing of plan members.

Notably, we observed that the share of total drug spending on the top 10 drugs saw a marked decrease in 2024. The top ten drugs accounted for 25% of the year’s spending, a decrease of 5% from 2023. We are proud to attribute this success to our robust biosimilar program and prior authorization on drugs such as Ozempic and the diabetic device Freestyle Libre. The proportion of claims for these top 10 drugs has increased by 2.5% (8.4% in 2024 vs. 5.9% in 2023). 

Top 10 drugs in a nutshell

The following table shows the top ten drugs in descending order of total amount reimbursed in 2024, as well as their respective rankings in 2023 and 2022.

^BBiological drugs

Not surprisingly,Ozempic and Rybelsus continue to lead in terms of overall expenditure. Our prior authorization program ensures the appropriate use of these therapies in patients with diabetes. Note that Wegovy, also a semaglutide product but used for weight loss, is categorized separately. In 2024, a drug of the same class, Mounjaro (tirzepatide), was marketed and while initial uptake may have been affected by limited dosage forms, we think it will likely have an impact on market share in 2025. When compared to semaglutide, this drug was more effective at reducing both A1C levels and body weight.

We have observed that the implementation of biosimilars has reduced spending on once-dominant drugs like infliximab (Remicade) and adalimumab (Humira). Consequently, the relative spend on treatments for attention deficit hyperactivity disorder (ADHD) has pushed these treatments up in the rankings. Drugs such as methylphenidate (Concerta and Biphentin) and lisdexamfetamine (Vyvanse) have therefore risen in the ranks, influenced in part by the growing recognition of ADHD and the introduction of single-source methylphenidate products. Generic versions of Vyvanse (lisdexamphetamine) were marketed in mid-2024, so we expect them to fall in the rankings in 2025.

Similarly, as the spend on adalimumab declines, biologic drugs Dupixent and Entyvio climbed in the rankings. Dupixent now has multiple indications, from skin conditions to asthma, whereas the specificity of Entyvio’s mode of action has made it a preferred agent for ulcerative colitis.

Biosimilars for ustekinumab (Stelara) were marketed in the first half of 2024 and the drug retained its fourth-place ranking. We see that the full effect of biosimilar switching initiatives has not yet been realized and we believe it will be more reflected in next year’s data. 

We consider that biosimilars will continue to be one of the most impactful factors on the drug spend. An effective biosimilar strategy is critical as additional biosimilars for both popular drugs like Eylea (aflibercept) for eye conditions and even for rare diseases are expected on the market shortly.

Weight management

Wegovy (semaglutide) made its debut in mid-2024, sparking discussion on drugs for weight management. We are confident in our management of these therapies through prior authorization to ensure both appropriate initial use and monitoring.

See our white paper on obesity management for further discussion on the impact of obesity on the workforce.

In our view, the landscape of weight management options is poised for growth as anticipation builds for the approval of tirzepatide in Canada (known as Zepbound in the U.S). The potential for enhanced results in weight loss make it likely that the conversation around facilitating access to these therapies will persist.

Management strategies

We continue to develop effective management strategies for our clients, such as supporting the transition to biosimilars and measures to ensure appropriate use of therapies such as those used for weight management.

These observations, which cover all claims processed by our Group Insurance line of business, do not necessarily apply to all the drug plans we administer.

If you have any questions, please contact your advisor or your iA Financial Group Account Executive.

We will send this communiqué to plan administrators on April 21.

See the French version.