Just 2.1% of claimants now drive more than one‑third of private drug‑plan costs
More than a third of private drug‑plan spending now goes to specialty medicines, even though just 2.1 percent of claimants use them.
That imbalance anchors TELUS Health’s 2026 Drug Data Trends & National Benchmarks, which tracks 2025 claims experience across Canadian private plans.
Specialty drugs with annual treatment costs of at least $10,000 accounted for 33.9 percent of total eligible amounts in 2025, up from 32.7 percent in 2024 and 31.2 percent in 2023.
Their share of claimants edged up to 2.1 percent from 1.9 percent and 1.8 percent.
The average annual eligible amount per specialty claimant actually slipped to $17,142.46 in 2025 from $17,484.62, so rising claimant counts now drive most of the growth.
Atlantic Canada posted the highest specialty share at 38.5 percent, followed by Quebec at 37.7 percent, Ontario at 34.0 percent and Western Canada at 26.7 percent.
TELUS Health links Western Canada’s lower share to Pharmacare and universal plans in British Columbia, Saskatchewan and Manitoba that step in as primary payor once members hit deductibles.
Ultra‑high‑cost drugs, defined as therapies with estimated annual treatment costs of at least $100,000, made up 5.2 percent of eligible amounts in 2025, up from 5.0 percent in 2024 and 4.9 percent in 2023.
Only 0.03 percent of claimants used them in 2024 and 2025.
The average annual eligible amount per claimant reached $190,446.32.
Trikafta for cystic fibrosis represented 47.7 percent of ultra‑high‑cost spending in 2025, with an annual treatment cost of about $300,000.
Ultomiris for rare blood and neuromuscular diseases held 7.6 percent and can cost up to $600,000 a year.
TELUS Health notes that even a single ultra-high-cost claim can be catastrophic for a drug plan.
The weight‑management category, classified as a lifestyle benefit that sponsors must opt into, recorded 104.0 percent growth in eligible amounts in 2024 and another 61.0 percent in 2025.
It now accounts for 2.5 percent of total eligible amounts and ranks 11th among all therapeutic categories.
Claimants increased 59.7 percent in 2024 and 21.6 percent in 2025.
Claims rose 90.1 percent and 54.9 percent.
The average annual eligible amount per claimant jumped from $1,572.57 in 2023 to $2,008.54 in 2024 and $2,658.43 in 2025.
Saxenda’s share of category spending dropped from 77.0 percent in 2023 to 20.5 percent in 2025.
Wegovy, which reduces body weight by 10 percent to 15 percent, took 68.7 percent of the category by 2025.
Zepbound, capable of lowering weight by 20 percent, entered the Canadian market in July 2025 and is expected to gain share.
TELUS Health also flags future products such as CagriSema and notes that more sponsors are adding weight‑management coverage because of its potential to improve comorbidities like cardiovascular and kidney disease.
Diabetes drugs and devices remained the top category by eligible amount in 2025 with a 13.2 percent share, ahead of skin disorders at 9.9 percent.
The category accounted for 7.6 percent of all claims.
Spending is now moving in the opposite direction.
Eligible amounts fell 6.8 percent in 2024 and 1.8 percent in 2025.
Claims declined 1.6 percent and 4.9 percent, and claimants fell 3.0 percent and 5.2 percent.
TELUS Health attributes this to measures that restrict diabetes drugs’ use for weight loss and to the launch of Wegovy, which shifted some volume into the weight‑management category.
Average eligible amounts stayed relatively stable at $153.33 per claim and $1,601.86 per claimant in 2025.
Ozempic still led the category with 39.4 percent of eligible amounts, down from 47.6 percent in 2023.
Freestyle Libre 2 Flash rose to 8.7 percent, Jardiance to 8.0 percent, and Mounjaro—launched in November 2023—reached 4.2 percent after showing stronger blood-sugar and weight-loss outcomes than Ozempic.
Health Canada is reviewing eight generics for Ozempic that are expected to launch at about 35 percent of its list price.
TELUS Health warns that if patients migrate to Mounjaro, savings from generic semaglutide could evaporate.
The Pharmacare Act for diabetes drugs and contraceptives took effect in October 2024. British Columbia, Manitoba and Prince Edward Island rolled out programs covering many contraceptives at no cost.
In BC, contraception claimants fell 24.8 percent in 2024 and 13.3 percent in 2025.
Manitoba saw drops of 9.5 percent and 66.5 percent, and PEI 3.6 percent and 23.1 percent.
Nationally, eligible amounts for contraception decreased 5.0 percent in 2024 and 5.7 percent in 2025, while average cost per claim and per claimant remained roughly flat at about $47 and $182.
TELUS Health expects further declines in private‑plan spending on contraceptives as more provinces sign on and claims are routed to pharmacare as first payor.
