Patient or Patient Group

A pharmacist helping a customer, both wearing masks, with medicine recommendations inside a pharmacy.

Why Do I Need Prior Authorization to Fill My Prescription?

Although specialty drug claims make up only a small portion of the number of total drug claims submitted under group benefit plans, specialty drugs make up an increasing amount of total drug claims and expenditure for employers and other sponsors of group benefit plans. In 2022, two important reports concluded that specialty drug spending in Canada has increased as a percentage of overall drug expenditures:

Express Scripts Canada reported that specialty drugs made up only 0.9% of total claims, but that they accounted for 29% of total drug spend in group drug plans, up 6.8% from the previous year.

TELUS Health reported that specialty drugs made up 34% of the total eligible amount despite only making up 1.4% of total claims.

Assuming these trends continue, TELUS Health predicts that by 2026, specialty drugs will account for almost half of the average eligible amount per certificate.