A surge in private drug plan use and spending on high-cost medicines is reshaping risk for Canadian plan sponsors and insurers, according to TELUS Health's 2026 Drug Data Trends & National Benchmarks Report, released at the TELUS Health Annual Conference.
Drawing on claims data from more than 15 million insured Canadians and trends dating back to 2008, the report pointed to continued growth in specialty and ultra-high-cost therapies, rapid expansion of weight-management drugs and widening regional differences driven by public policy. Private drug plans now account for roughly 38% of all prescribed drug spending in Canada, making cost trends in this segment a key concern for insurers and employers.
“This year’s data shows a system under productive pressure. More people in Canada are using their drug plans and they’re accessing treatments that were unattainable a few years ago,” said Vicky Lee, pharmacist and director of pharmacy consulting and professional services at TELUS Health. “However, the resulting cost pressures emphasize the need for plan sponsors, insurers and advisors to implement robust risk management for long‑term drug plan sustainability.”
Plan utilization continued to climb in 2025. TELUS Health reported that 61.8% of insured members made at least one claim, up from 58.7% in 2023. The average number of claims per claimant held steady at 12.2, but the average annual eligible amount per claimant increased to $1,079.04 from $1,036.67 in 2024.
More members claiming and higher spend per claimant indicate a rising baseline cost for private plans, even before the impact of individual high‑cost cases. Federal analyses have highlighted the same pattern, with increased use of newer, more expensive medicines identified as a primary driver of private plan expenditure growth.
Specialty drugs remained a disproportionate driver of private plan costs. In 2025, they represented 33.9% of total eligible drug spend while being used by only 2.1% of claimants.
Within that group, a new generation of ultra‑high‑cost therapies is reshaping risk concentration. These drugs accounted for 5.2% of total eligible spend last year. The number of claimants using them grew by 12.2%, yet they still represented just 0.03% of all claimants, with an average annual eligible amount of $190,446.32.
Trikafta, a cystic fibrosis therapy, dominated ultra‑high‑cost spend at roughly $300,000 per year and 47.7% of that category’s eligible costs. Ultomiris, used for rare blood and neuromuscular disorders, ranked second at up to $600,000 annually.
This level of concentration reinforces the need to review pooling thresholds, stop‑loss structures, prior authorization rules and case management to manage volatility from a small number of very high‑cost claimants.
Weight‑management therapies continued their rapid rise, climbing six positions to become the 11th‑largest drug category by spend. The segment grew 61.0% in 2025 after 104.0% growth in 2024 and now accounts for 2.5% of total eligible spend.
Zepbound (tirzepatide), which can reduce body weight by up to 20%, became available in July 2025 and is expected to gain market share quickly. A generic version of Ozempic is anticipated in late 2026 at about 35% of list price, which TELUS Health estimates could reduce annual treatment costs from approximately $1,500–$6,100 to roughly $500–$2,100.
For benefit plans, this combination of expanding indications, strong member demand and shifting pricing in GLP‑1–based therapies will require ongoing review of coverage criteria, prior‑authorization processes and member cost‑sharing.
The report also noted changes in the therapeutic mix. Skin disorders overtook inflammatory diseases to become the second‑largest category by spend, accounting for 9.9% of total costs. TELUS Health attributed this to biologics such as Dupixent and Skyrizi moving into first‑line use for atopic dermatitis and psoriasis. The category’s eligible spend rose 13.6% in 2025, while average cost per claimant increased 14.2%.
Cost‑management tools are gaining some traction. In 2025, 67.4% of biologic claimants used a lower‑cost biosimilar, up from 44.6% in 2023, while generics accounted for 70.8% of all claims. Federal data similarly show increased biosimilar and generic use as one of the few counterweights to specialty‑driven cost growth in private plans.
Demographics remain a structural driver. Claimants aged 45–64 represent 38.5% of claimants but account for 56.4% of total eligible spend, underscoring mid‑career workers as a key pressure point for employer‑sponsored coverage.
Public policy is beginning to reshape private plan exposure, particularly in diabetes. Canada’s Pharmacare Act, passed in 2024, launched a first phase of national universal pharmacare focused on diabetes medications and contraception. Manitoba and Prince Edward Island rolled out programs in 2025, and British Columbia joined in March 2026. Diabetes drugs are currently the top private‑plan category at 13.2% of spend; as more provinces participate, private exposure to this class is expected to decline as some funding shifts to public programs.
Regional cost patterns remain divergent. Atlantic Canada recorded the fastest growth in average eligible amount per claimant at 5.5%, compared to 4.1% nationally and 3.5% in Western Canada, reflecting a higher share of specialty spend in the region. In Quebec, 30‑day dispensing practices drive the highest claim frequency at 17.5 claims per person, resulting in lower average cost per claim but the highest annual cost per claimant at $1,355.25.
By contrast, universal drug plans in British Columbia, Saskatchewan and Manitoba keep Western Canada’s average annual cost per claimant at $787.41, nearly 42% lower than in Quebec. Western Canada also saw the fastest growth in specialty drug share, up 3.9% in 2025 following an 8.4% jump in 2024.
TELUS Health characterized the environment as one where access to innovation is expanding, but so are volatility and long‑term cost trends. Federal research has reached similar conclusions, finding that private drug plan spending is rising at a pace comparable to public plans, with high‑cost medicines as the dominant driver.
“An evidence‑based plan design is critical,” Lee said. “The convergence of ultra‑high‑cost therapies, a maturing weight‑management market and the availability of generics means a thoughtful approach that balances the complex intersection of costs, medical innovations and regional policies is required to continue supporting the evolving healthcare needs of people in Canada.”
The data point to a need for more granular risk management: tighter specialty drug strategies, reconsideration of pooling limits for ultra‑high‑cost claimants, closer alignment with evolving Pharmacare programs and regional policy settings, and more active use of biosimilar and generic substitution.
For plan sponsors, they underline that benefit design, member cost‑sharing and broader health and wellness strategies will all play a larger role in keeping private drug coverage sustainable as high‑cost therapies and weight‑management drugs continue to reshape the Canadian drug benefit landscape.
