It’s helpful to understand the conditions that impact your plan members and organization, as well as the resulting costs. This is why Alberta Blue Cross® monitors and reviews drug claiming information and provides insight into the most common health conditions and 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*
| 2023 rank | Health condition | 2022 rank |
| 1 | Diabetes | 1 |
| 2 | Attention Deficit Hyperactivity Disorder (ADHD) | 3 |
| 3 | Crohn’s disease or ulcerative colitis | 2 |
| 4 | Rheumatoid arthritis | 4 |
| 5 | Depression | 5 |
| 6 | Asthma or Chronic Obstructive Pulmonary Disease (COPD) | 6 |
| 7 | Multiple sclerosis | 7 |
| 8 | Psoriasis | – |
| 9 | Skin conditions | 10 |
| 10 | Disorders requiring neurotoxins | 9 |
Top 10 health conditions based on number of claims*
| 2023 rank | Health condition | 2022 rank |
| 1 | Depression | 1 |
| 2 | Cardiovascular disease | 2 |
| 3 | Diabetes | 3 |
| 4 | Infection, antibiotic | 4 |
| 5 | Asthma or COPD | 5 |
| 6 | ADHD | 8 |
| 7 | High cholesterol | 6 |
| 8 | Reflux or ulcer | 7 |
| 9 | Allergy (seasonal) | 9 |
| 10 | Thyroid disorders | 10 |
The top 10 health conditions by number of claims provides insight into the most common conditions impacting plan members. These conditions account for approximately 60 per cent of total drug claims in 2023. Many of these conditions have lower-cost treatment options, such as antibiotics or blood pressure medications. So while these treatment options are commonly used, they are less costly to the plan. However, some notable conditions that appear on both lists are diabetes and ADHD, which rank first and second by spend respectively.
Diabetes continues to have an impact on private plans, ranking as the top health condition by spend for the past 3 years. According to Diabetes Canada, more than 4 million, Canadians are affected by diabetes[1]. In addition, we are seeing more members using higher-cost, add-on therapies, such as Ozempic, to manage their diabetes. The prevalence of diabetes, along with increasing use of newer, more expensive diabetes medications has contributed to diabetes remaining the top condition by spend in 2023.
The amount of members making a claim for ADHD medications has increased from 2022, resulting in ADHD becoming the second highest condition by spend. One of the most commonly used medications for ADHD is Vyvanse, which often ranks among the top 10 drug for private drug plans. Vyvanse has several generic alternatives currently under review by Health Canada and is one of the last ADHD medications to have a generic available. Once approved and marketed, generics for Vyvanse will provide a lower-cost option, resulting in some savings in this category.
Other health conditions that account for a high portion of drug spend are conditions that affect a smaller number of members but have high-cost therapies associated. Conditions like Crohn’s disease or rheumatoid arthritis often rank in the top 5 conditions by spend due to their treatment, which usually involves specialty drug therapies that cost more than $10,000 each year.
As drug costs continue to increase, plan management strategies become more important to maintain plan sustainability. Step therapy and special authorization are critical features for ensuring proper management of higher-cost therapies. Generic pricing and maintenance medication programs can result in savings on more commonly used, lower-cost therapies. For more information on this, please speak with your Alberta Blue Cross® representative.
*The rankings above are based on 2023 Alberta Blue Cross® private plan drug claims data and reflect Health Canada-approved indications (health conditions) of the medications.
