Average eligible amount per claim rose by 2.4% in 2024 in Canada: report
Employers spent a little more for their sponsored drug plans in 2024 compared to the previous year, according to a report from TELUS Health.
Six out of 10 (60.5%) members of employer-sponsored drug plans submitted at least one claim in 2024, a modest increase from 58.7% in 2023. These claimants submitted an average of 12.1 claims each, nearly identical to 2023’s figure of 12.0.
The average eligible amount per claim rose by 2.4%, increasing from $83.53 in 2023 to $85.52 in 2024. On an annual basis, each claimant averaged $1,037.95 in eligible claims in 2024, up 3.3% from $1,005.03 the previous year—and significantly higher than the $667.78 average in 2015.
Spending is expected to continue climbing, said Vicky Lee, Director, Pharmacy Consulting & Professional Services, Payor Solutions, TELUS Health.
“We forecast an annual growth rate of between 3% and 8% for the next five years, due to a combination of increased utilisation and more high-cost drugs.”
Aon forecasts that Canadian employer medical costs in 2025 will increase by 7.4% in 2025, following an increase of 5.0% in 2024.
Which medications were most popular among claimants?
Drugs for diabetes, inflammatory diseases, and skin disorders remained the top therapeutic categories by spending under Canadian workplace drug plans in 2024, according to TELUS Health.
Semaglutide—sold under the brand name Ozempic—was the highest-cost drug ingredient, accounting for 6.6% of total eligible drug spending. However, overall spending in the diabetes category dropped by 7.3%, in part due to patients shifting from off-label use of Ozempic for weight loss to the newly available Wegovy, which is specifically approved for that purpose.
“Even before Wegovy, measures to control the off-label use of Ozempic were slowing the growth in claimant count,” said Lee.
She added that shortages of Ozempic and other diabetes medications may have impacted utilisation and triggered switches to lower-cost alternatives.
Drugs for inflammatory diseases, led by infliximab, ranked second in total eligible amounts at 8.9%. Skin disorder medications came in third at 8.7%, bolstered by growing use of high-cost therapies such as Dupixent (dupilumab). Both categories consist largely of biologic and specialty medications.
Weight-management drugs emerged as the fastest-growing therapeutic class in 2024. Claimant numbers surged by nearly 60%, and the total eligible amount more than doubled. Wegovy quickly captured 31.1% of claimants within eight months of launch, while Saxenda remained the most prescribed, with 44% of claimants.
Migraine medications also saw a resurgence. The category rose to 19th place in total spending, spurred by new CGRP inhibitors such as Qulipta. Spending in this area rose 25.4%, with the average cost per claimant reaching $603.53.
Specialty drugs in Canada
TELUS Health also found that specialty drugs—those costing $10,000 or more annually—now account for 32.8% of all private drug plan spending. Trikafta, a treatment for cystic fibrosis, led the ultra-high-cost category, representing more than half of that segment’s total spend. Its estimated annual cost per patient is $300,000.
Biosimilar medications continued to gain traction, with 56.9% of biologic drug claimants using biosimilar alternatives—up from 44.6% in 2023. Biosimilars of pegfilgrastim and rituximab achieved adoption rates of over 95%.
“Private drug plans are well utilized and highly valued by plan members. Growth rates were small to moderate in 2024, offset in part by generic drugs and biosimilar biologics. Yet specialty drugs now account for almost one-third of the dollar amount of claims submitted to private plans for coverage, and more ultra-high-cost drugs for rare diseases are on the horizon,” according to TELUS Health’s The 2025 Drug Data Trends & National Benchmarks report.
“Striking the right balance between value for plan members and affordability for plan sponsors is increasingly complex.”
In October 2024, Canada’s Pharmacare Act received Royal Assent and immediately came into force.
“Everyone in Canada deserves access to the care they need, including to prescription medications,” said Mark Holland, minister of health, back then. “Our plan for universal access to contraception means reproductive freedom and choice and access to diabetes medication is a transformational step towards improving health outcomes and health equity in Canada. I thank all partners for their contributions to making this happen.”
