Understanding what conditions are impacting your plan members and your organization, as well as the resulting cost, is important. Alberta Blue Cross® monitors and reviews drug claiming information to provide insight into the prevalence of health conditions in our populations and the associated costs that can impact plan sustainability in the future.
The following are the top 10 health conditions ranked by total amount paid (Table 1) and by number of claims (Table 2).
Top 10 health conditions based on amount paid*
|2||Crohn’s disease/ulcerative colitis|
|3||Attention Deficit Hyperactivity Disorder (ADHD)|
|6||Asthma/Chronic Obstructive Pulmonary Disease (COPD)|
|9||Disorders requiring neurotoxins|
Top 10 health conditions based on number of claims*
As can be seen above, there are a mix of conditions at play in the top 10 conditions. Non-modifiable conditions such as Crohn’s disease and rheumatoid arthritis represent higher-cost, lower-frequency claims. By contrast, cardiovascular disease, high cholesterol and diabetes—typically viewed as conditions where the disease severity can be modified—are among the top conditions by number of claims as well as by amount paid.
In 2022, we noted an increase in medications used for the treatment of diabetes and ADHD. The growth in diabetes can be attributed to an increase in the number of members submitting claims and an increase in spend for newer diabetic drugs that have a dual action of blood glucose control and moderate weight loss. Marked growth in this class of medication highlights the importance of effective plan management tools, such as step therapy and special authorization to ensure appropriate use. Rising awareness and changes in the clinical approach of ADHD management has led to an increase in the number of members submitting claims for ADHD. Vyvanse, one of the last medications in this drug class without a generic version, continues to drive spend in this category. Plans with generic pricing in effect can expect some financial relief as a generic medication for Vyvanse will make its way to the market soon.
While lifestyle changes generally have limited impact on non-modifiable conditions, some of the more modifiable conditions noted above can be tackled through education, diet and physical activity. Wellness initiatives, such as the Alberta Blue Cross® Balance® platform, can help. Balance® helps users assess and track their health and wellness habits and includes features like medication and activity reminders and educational articles. The Alberta Blue Cross® care navigation site also provides various health and wellness resources for Albertans and plan members, such as chronic disease management and mental health support, by sharing trusted, reliable services and programs. For more information on this and other resources available to help manage health, please speak with your Alberta Blue Cross® representative.
*The rankings above are based on 2022 Alberta Blue Cross® private plan drug claims data and reflect Health Canada-approved indications (health conditions) of the medications.
Balance® is a registered mark of the Canadian Association of Blue Cross® Plans, an association of independent Blue Cross® plans.