Trends in Drug Claims 2020

Although it differs from one employee group to another, there are definite common claiming patterns among ASSOCIUM Benefits clients, and the general population. Knowing those patterns and taking steps to reduce their impact on costs are part of good plan management.

Overall plan spending on prescription drugs increased nominally into 2019 and 2020 within the ASSOCIUM block, by approximately 2.5%. While specialty drugs represented the largest category of medication, the spend was much lower as a percentage than  previous years representing just less than 15% of claims made compared to over 30% in 2017-2018. The good news is, our Specialty Drug program has helped reduce the impact on ASSOCIUM clients.

Industry analysis shows that just 20% of claimants drive almost 80% of plan costs with an average annual drug spend that is much higher than that of other claimants. Members in this group have, on average, twice to three times chronic conditions and take 8 or more medications.

In reviewing the spending patterns of ASSOCIUM clients

  • High cost specialty medications, which make up .5% of total claims made, account for 15% of total spend. (our specialty drug program has helped  to reduce that figure)
  • Anti-depressants make up about 17% of all claims 
  • Diabetic medications add another 14% of claims
  • Medication for inflammatory conditions, anti-psychotics, asthma, ant-acid and cholesterol accounted for 5% each of overall spending.

The number of mental health-based medications, including anti-depressants, anti-psychotics and anti-convulsants (such as Clonazepam) comprise over 20% of all claims when combined. This statistic also serves to underscore the need for more action around the treatment of mental health. ASSOCIUM offers an Employee Assistance Plan and is dedicated to working with carriers to introduce more effective solutions.

The next largest single therapeutic category is diabetes. We see a high prevalence of this among clients with a higher population of South Asian employees, as much as 30%, compared to 14% as a general average. While diet and lifestyle are primary factors, genetics can also play a significant role. Early detection gives individuals a chance to control or even prevent the onset of diabetes, whether due to lifestyle or genetics.

Understanding the health of your workforce and taking steps toward improvement can help reduce absenteeism, presenteeism and benefit plan costs. Let us know if you would like ASSOCIUM Benefits to help.

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ASSOCIUM Benefits is a very unique employee group benefits provider, focused on supporting benefits Advisors and their employer clients. We provide Brokers and Plan Sponsors with a range of solutions from traditional group benefits to more customized, cost and tax effective employee compensation. Let’s connect to find out how we can help.