2017 Retrospective Data Trends and National Benchmarks

by Shawn O’Brien – Principal – TELUS Health


Content outline

I. Terminology and background
II. Key results
III. Drug type utilization
IV. Specialty drug analysis
V. Opioids
VI. Medical marijuana
VII. Book of business rankings


Terminology and background

  • Insured : any covered individual i.e. employee, spouse or child
  • Certificate : the employee and the linked dependants
  • Average age : average age of the insureds or the employees depending of the context
  • Utilization : number of claims paid per certificate or insured depending of the context
  • Eligible cost : the cost of the drug found eligible by TELUS Health. (This measure does not take account of the deductible or co-insurance)
  • Average quantity : total submitted quantity divided by total number of scripts
  • Unit cost : average eligible cost per script divided by the average quantity


Comparison with a specific group

  • Results reflect the entire TELUS Health book of business (BoB)
  • Results may differ significantly from plan to plan.
    The following elements have an important impact on the costs :
    – Plan coverage
    – Demographics : Age distribution, Gender distribution, Number of dependants
    – Provincial distribution
    – Industry

For renewal, the factors used by carriers are based on many other elements :

  • Group experience
  • The entire medical claims not only drugs
    (including hospital, paramedical, out-of-country, etc.)
  • Higher volatility for a specific group compared to TELUS Health BoB
  • Ageing of insured population
  • Renewal is a prospective exercise, our analysis is retrospective
  • Single-source brand
    drug for which no generic exists
  • Multi-source brand
    one or more generics exist
  • Generic
    bioequivalent drug that is a copy of the innovator molecule


Except if otherwise mentioned, data in this presentation is based on:

  • Insured aged less than 65
  • Costs are eligible costs, i.e. before deductible and co-payment


Read the full document: Retrospective 2017 data trends and national benchmarks