High-Cost Drug Risk Is Now a Business Risk
We’re in a moment of structural change in how prescription drug costs are handled in Alberta.
High Cost Specialty Drugs & Benefit Plan Sustainability
Over the past decade, high-cost specialty medications have become the largest driver of benefit plan inflation in Canada.
These medications are commonly used to treat conditions such as:
- Rheumatoid arthritis
- Crohn’s disease
- Psoriasis
- Severe asthma
- Autoimmune disorders
While these medications can dramatically improve quality of life, many now cost $20,000 to $80,000+ per patient per year, and some exceed $150,000 annually.
For many employer benefit plans, a single claimant can dramatically impact premiums.
Example:
- A $60,000 drug claim can equal the annual cost of 15–25 employees on a typical benefits plan.
Because of this, employers across Canada are increasingly reviewing strategies to manage high-cost drug exposure while still ensuring employees receive the medications they need.
Access to Medication Support Programs
The good news is that most specialty medications are supported by manufacturer-funded patient assistance programs.
These programs help patients:
- Coordinate insurance coverage
- Access financial assistance
- Reduce or eliminate copayments
- Navigate provincial drug programs
- Access nursing and case management support
Employees who require these medications are strongly encouraged to contact the applicable support program.
Alberta Blue Cross Non-Group Coverage
Recent legislated changes to the Alberta Blue Cross Non-Group Drug Program have improved access to coverage for Albertans requiring extremely high-cost medications.
WellnFlex has communicated these changes to all clients and can assist employees in navigating provincial coverage options if needed.
Managing Drug Claim Risk for Employers
Many employers are now implementing strategies such as:
- Annual drug maximums
- Managed specialty drug programs
- Case management for high-cost claims
These approaches help ensure:
- Employees still receive access to treatment
- Benefit plans remain financially sustainable
- Premium increases remain predictable
How WellnFlex Helps
WellnFlex works with employers to:
- Analyze high-cost drug exposure
- Model the financial impact of specialty drug claims
- Compare plan designs that reduce risk
- Ensure employees have access to assistance programs
If you would like to review how high-cost drugs may impact your benefit plan, our team would be happy to prepare an analysis.
Contact us to Flex more savings but keep your employees covered!
Common High-Cost Drugs & Support Programs
Rinvoq
Used for: Rheumatoid arthritis, Crohn’s disease, ulcerative colitis
Support Program: AbbVie Care
Phone: 1-866-848-6472
Website: https://www.abbviecare.ca
Humira
Used for: Rheumatoid arthritis, Crohn’s disease, psoriasis, ulcerative colitis
Support Program: AbbVie Care
Phone: 1-866-848-6472
Website: https://www.abbviecare.ca
Skyrizi
Used for: Crohn’s disease, psoriasis
Support Program: AbbVie Care
Phone: 1-866-848-6472
Website: https://www.abbviecare.ca
Stelara
Used for: Crohn’s disease, psoriasis
Support Program: Janssen BioAdvance
Phone: 1-844-214-4714
Website: https://www.bioadvancemail.ca
Tremfya
Used for: Psoriasis, psoriatic arthritis
Support Program: Janssen BioAdvance
Phone: 1-844-214-4714
Website: https://www.bioadvancemail.ca
Enbrel
Used for: Rheumatoid arthritis, psoriatic arthritis
Support Program: Enliven Services
Phone: 1-877-936-2735
Website: https://www.oneenliven.ca
Cosentyx
Used for: Psoriasis, psoriatic arthritis, ankylosing spondylitis
Support Program: Novartis GO Program
Phone: 1-855-668-6777
Website: https://www.cosentyxgo.ca
Dupixent
Used for: Asthma, eczema, chronic sinusitis
Support Program: Dupixent MyWay
Phone: 1-844-387-4936
Website: https://www.dupixent.ca
Xolair
Used for: Severe asthma, chronic hives
Support Program: Xhale Program
Phone: 1-866-972-9546
Website: https://www.xolair.ca
Taltz
Used for: Psoriasis, psoriatic arthritis
Support Program: LillyPlus
Phone: 1-844-825-8966
Website: https://www.lillyplus.ca
Turn High-Cost Drug Risk into Predictable Planning
High-cost drug claims don’t have to create financial surprises for your benefit plan.
Wellnflex helps employers anticipate exposure, manage costs, and design sustainable, long-term strategies that keep your plan — and your organization — stable.
We focus on:
- High-cost drug exposure modeling
- Risk forecasting
- Claims volatility planning
- Plan sustainability design
- Catastrophic claim containment strategies
- Governance-based benefit structures
- Long-term cost engineering
- Renewal shock prevention
Your benefits are more than coverage — they’re a business asset.
We don’t react to claims — we design systems that absorb them. Let’s protect them together.