Managing employees' neurological conditions

Neurological conditions are beginning to take up more space in the health benefits conversation and one health expert asserts plan sponsors need to pay closer attention, notably from a cost and productivity standpoint.  

“Our claims are rising for adults,” said Frances Lehun, pharmacist, pharmaceutical expertise and high-cost drug management at Beneva, pointing to Attention Deficit Hyperactivity Disorder (ADHD) claims. “It's also considered a chronic disease because there's no cure for ADHD. What we have is a medication that can help with the symptoms… The cost of medication is low and we want more awareness for helping our employees that have a new diagnosis.”

ADHD may be commonly associated with childhood, but Lehun believes the employer blind spot lies with adults. She explained ADHD is a chronic neurodevelopmental disorder with hereditary roots, meaning a child’s diagnosis often leads to one for a parent. What used to be dismissed as disorganization or anxiety, especially around chronic lateness, difficulty with time management, problems with completing tasks is now recognized as part of a diagnosable and treatable condition.

She also pointed to the common co-occurring conditions that can exacerbate the impact of ADHD in adults.

“We have higher mental health comorbidities,” Lehun explained, noting that depression, anxiety, and even substance abuse can be more frequent in this population. Even in the work environment, untreated ADHD is linked to reduced productivity and job instability, said Lehun.

“Sometimes we'll frequently change jobs, and that affects also the pay,” she said. “Employers have a harder time to give raises when someone changes jobs frequently.”

“Everybody’s different. Comorbidities are different so nobody will get probably the same treatment,” she added.

Medications remain a key tool to combatting neurological diseases, and Lehun noted that the main options are now available in cost-effective generic forms.

“We think about Concerta, Vyvanse, Biphentin, FOQUEST and the costs vary between $20 to $120 depending on the dose and the form,” she said.

Still, generics have softened the financial blow as ADHD drugs now account for 6.4 per cent of total drug costs at Beneva. Though that figure predates the availability of generic Vyvanse, Lehun noted.

The real concern, however, is the surge in new adult diagnoses since the pandemic.

“We saw the shift,” she explained, pointing to 2020 as the inflection point. “Kids were at home and adults who were working full time had their kids at home. So maybe there were lots of new stimulations or new symptoms that arose with that complicated situation.”

Based on claim volumes and overall prevalence, she sees ADHD as a major driver of workplace health impacts. She explained that even with the growing number of diagnoses, cost control hasn’t yet become an issue as there’s lots of generics available on the market, which helps keep treatment affordable for both plan sponsors and plan members.

But that doesn’t mean plan sponsors should be passive as she urges greater attention from employers, particularly as ADHD can lead to a loss in productivity. She reinforced the idea that even low-cost conditions can have high-impact consequences if left unmanaged.

That's why she advocates for a comprehensive strategy that integrates early diagnosis, cost control, and workplace adaptation. This includes promoting awareness of ADHD symptoms among employees, supporting personalized treatment plans, and offering access to both medication and non-drug interventions.

Cost management also plays a crucial role, she noted, with an emphasis on generic options, step therapy, and prior authorization for higher-cost treatments. Equally important are workplace accommodations, such as flexible schedules, organizational tools, and environments that recognize the challenges ADHD presents.

Finally, she also encourages proactive monitoring of drug claim trends and their effect on productivity, using data to inform targeted support programs. She underscored the goal is to treat ADHD as a manageable condition through coordinated medical, financial, and organizational efforts.

Migraine, an upredictable, debilitating neurological condition

Migraine is another neurological condition that Lehun explains is unpredictable as it is debilitating, especially for those between 30 and 50-year-olds. That means working-age adults are carrying the brunt of this burden.

“Migraine is a throbbing headache, and it can occur in attacks. We know that an attack of a migraine lasts anywhere from four hours to 72 hours. Imagine having a migraine for 72 hours and trying to be productive at work. It can really have an impact on the employer, also, when your employees suffer from migraine,” she said.

“We know that around 20 per cent of absences at work can be due to a type of headache,” she added.

While over-the-counter solutions like acetaminophen and non-steroidal anti-inflammatory drugs help, others require advanced treatments for more persistent cases.

Lehun outlined a range of preventatives, from generics like Elavil or Topamax which go for roughly $15 a month with others exceeding $7,000 annually, including monoclonal antibodies like Aimovig and Vyepti. These high-cost treatments often require prior authorization and regular reassessment.

She also emphasized that treating a medical condition often means addressing more than just the core symptoms. She suggests the answer is just more than prescriptions but “a combination of the pharmacological and psychosocial intervention.” She suggests any intervention, particularly pharmaceutical, can extend its benefits beyond the primary diagnosis.

“When we talk about a disease, yes, you have the disease, but you have all the comorbidities attached to it also,” she noted.

“The drug that can help a disease can also help with all the comorbidities,” she said, also pointing to a connection between other conditions like obesity, migraines, and adult ADHD, and their overlapping ties to mental health challenges.

But medication alone isn’t enough as Lehun underscores having supportive integrated care models that include therapy, physical health services, and employer-based initiatives.

“If you help that disease, and you have also programs in place to help with mental health at the same time, or other components like psychology, kinesiology and Employee Access Programs, that can help.”