Pooling charge for expensive prescription drugs

You may have noticed in the renewal conditions of your group benefits plan a significant increase required for the pooling charge for expensive prescription drugs. Indeed, the increases announced last fall by the Quebec Drug Insurance Pooling Corporation (QDIPC) for calendar year 2021 are beginning to have an impact on renewals. The increases required vary between 20% and 50% depending on your group size. Although these pooling charges represent a small portion of the total premium for healthcare (between 5% and 30%), the impact is still considerable. As a reminder, all insurers in Quebec must participate in the QDIPC for groups with less than 6,000 members. During the 25 years of its existence, the average increase for QDIPC pooling charges has been about 15% per year, combined with a pooling threshold that has been multiplied by five for a typical group with 100 members.

There is good news though! The drug Humira, which treats certain chronic inflammatory conditions and is one of the most expensive drugs in Canada, now has biosimilars approved by Health Canada. These biosimilars represent a less expensive alternative that will eventually have a positive financial influence on pooling charges of group benefits plans. Note that some Canadian provinces such as British Columbia and Alberta, have already implemented a biosimilar substitution policy. In Quebec, we are still waiting for such a policy to fully get the savings related to biosimilars. Here are the biologic drugs for which the public plan in Alberta requires substitution for a biosimilar (Humira will appear on that list eventually):

HUB International’s team of advisors has extensive experience in designing the full range of employee benefit programs and can help you gather the data you need to navigate the benefits renewal process efficiently and effectively.

Sources:

• Government of Alberta - Biosimilar drugs: https://www.alberta.ca/biosimilar-drugs.aspx
• Sandoz Canada completes its 5th biosimilar launch with new biosimilar Hyrimoz® (adalimumab) : https://www.sandoz.ca/fr/stories/global-impact/sandoz-canada-lance-son-5eme-biosimilaire-hyrimoz-adalimumab
• Viatris Launches Hulio® (adalimumab biosimilar) in Canada : https://www.newswire.ca/fr/news-releases/viatris-lance-huliomd-biosimilaire-de-l-adalimumab-au-canada-840200657.html#:~:text=a%20annonc%C3%A9%20aujourd'hui%20que,les%20indications%20de%20l'adalimumab