Newer and higher-cost medications are driving increases in a number of areas
When I talk to clients about prescription drug coverage, one of the questions I get asked most often is quite simply, “Where are claims and costs expected to go in the future?” It’s an important question, given that drug costs constitute the majority component of most benefits plans.
There are many factors driving changes in prescription drug utilization and the corresponding claims and costs. New medications are continually being introduced. Older medications go off-patent and are replaced by lower-cost generics. Changing demographics in our work force result in changing healthcare profiles. The regulatory framework is always evolving. And plan members have changing priorities that affect the care they expect to receive.
From what I’ve seen and heard in the last couple of years, along with information I’ve been able to find in researching this topic, I’d say that there are several trends in utilization of prescription drugs that we should be watching right now.
1 . Weight-Management Drugs (GLP-1 Agonists): For much of the last decade, diabetes-related medications were the fastest growing class of medications covered by drug plans. It was from this sector that the GLP-1 drugs emerged when it became known that they could also be used to help patients lose weight.
Ironically, the diabetes-related drugs, while still a major cost contributor according to Western Medical Assessments, have actually fallen off slightly in total claims to prescription drug plans in the last two years – but only because off-label use of diabetes drugs like Ozempic has dropped with the introduction of products such as Wegovy and Mounjaro that are indicated specifically for weight loss.
Now the class of GLP-1 weight-loss drugs is by far the fastest growing sector in prescription drugs. New products are coming on-stream, along with different formulations, such as daily pills versus weekly injections that are hitting the market.
According to the TELUS Health 2025 Category Watch report, the number of benefits plan members submitting claims for GLP-1s increased by 60% in 2025 and total spending more than doubled. Growth, they note, was primarily driven by transition from off-label use of similar drugs, and an increasing number of drug plans that cover weight-loss drugs (usually with restrictions such as high body-mass index or comorbidities).
Despite steady growth in this sector, total costs remain relatively modest, TELUS notes, due to the limited number of plans that provide full coverage.
I would expect growth in this sector to continue for some time, due to several trends: mainstream acceptance of GLP-1s as a first line go-to for weight loss; increased competition among drug makers bringing out new and different forms; and gradual reduction in cost, as we are already seeing in some cases.
2 . Specialty Biologic Drugs: Specialty drugs, such as Dupixent or Infliximab, are defined as drugs that typically cost more than $10,000 per year. They accounted for 32.8 percent for private drug plan spending in 2025, according to Western Medical Assessments.
I see two separate trends in this sector. First, according to the Patent Medicine Price Review Board (PMPRB) there is a shift taking place toward newer, high-cost medicines that is driving steady growth in cost. However, second, there is steady improvement in the availability and utilization of biosimilar alternatives (less costly drugs that have similar therapeutic effects). According to TELUS, the biosimilar adoption rate is now at 44.6 percent. This is significantly reducing the rate of cost increases overall.
3 . Migraine Therapies (CGRP Inhibitors): Migraine-related medications, such as Qulipta or Aimovig, have been driving costs higher in recent years, and annual costs per claimant now exceeds $600. Factors driving the raising cost include higher unit costs and the growth in preventive use of these medications.
4 . ADHD Medications: Medications used to treat attention deficit hyperactivity disorder (ADHD), such as Adderall XR or Concerta, have been driving costs higher due both to cost increases per unit and increased utilization. In addition, there is a a growing trend to adult use of these drugs – as opposed to school-age children, who were initially the primary patients – and long-term therapy.
5 . Dermatology and Immunomodulators: Dermatology drugs, such as Dupixent now represent 8.7 percent of private drug plan cost, according to Western Medical.
Key drivers of increased cost include the emergence of new classes of biologic therapies that are replacing traditional topical and systemic treatments. Also, newer treatment models tend to require long-term use rather than short courses.
6 . Oncology Drugs: Cancer drugs typically represent less than 1 percent of claims, but costs are around 5 percent of total private drug plan payments. Growth in this area has been slow and steady, and is expected to continue, according to Innovative Medicines Canada.
7 . Cholesterol management drugs: While the overall cost of cholesterol management drugs has been fairly steady for a number of years, due mainly to the fact that most of the drugs in this class have long been out of patent and replaced by generics, there are a couple of trends to watch. First, there are new drugs, called PCSK9 inhibitors, that are now available for patients who have not responded to conventional drug therapy. Second, use of these drugs is growing among millennials and Gen X patients. PCSK9s currently apply to less than 1 percent of claimants, but significantly higher prices can drive up total costs.
Overall, when I look at the trends in prescription drug spending, I note that increased use of higher-cost medicines is the primary driver of cost – not just increased numbers of prescriptions or even rising dispensing costs. Of course, it’s nothing new and it’s not going away. While there’s not much we can do about drug prices, there are things you can discuss with your benefits consultant that will help manage overall costs and ensure you and your plan members are getting maximum value for your dollar.
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I really appreciate comments, ideas, suggestions or just observations about the blog or any other topics in benefits management. I always look forward to hearing from readers. If there’s anything you want to share, please email me at bill@penmorebenefits.com.
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