Private Market

Government Cost Shifting

The private market is concerned about government cost shifting, two tiered pricing and the impact of biologic and specialty drugs.
Because of an increased trend in delayed or denied public funding of new drugs, private drug plans are sometimes the only payer for new and innovative therapies.
Because of the complexity of the private market, patient access programs are becoming necessary to help patients navigate their coverage. The investigation and navigation process can be time consuming and patients can be lost if they or their physician become frustrated and impatient
Private drug plans are key to the Canadian healthcare system

Private Drug Plans are paying a growing share of Canadian drug costs. Private payers (insurers and out-of-pocket) pay $15.4 billion or 55.5% of all Canadian drug expenses and their share is growing at a much faster than public drug plan costs.1
57% of Canadians have access to a private employer-sponsored health plan. 2
Averaged across all provincial public drug programs, as of January 1, 2012, only 23.0% of all drugs that Health Canada approved as safe and effective in 2004 had actually been approved for reimbursement (fully or partially) by the provinces, whereas at least one private insurer reimbursed 97.9% of all new drugs 3

Private drug plan managers are concerned about the sustainability of their drug plans.
Plan sponsors are particularly concerned about the cost of biologic or specialty medications which represent 22 % of the national drug spend but only 1.2% of all claims. 4
The rate of growth in biologic drug spend is increasing at 13.3% per year, compared to 4.2% per year decrease for all other drugs and they are estimated to be 25-30% of private drug plan spend in 2017. 4