A closer look at how chronic conditions are impacting benefits plans

The survey also found 54 per cent of benefits plan members currently live with at least one diagnosed chronic health condition, while 59 per cent have been diagnosed at some point in their lives.

Read: 54% of benefits plan members currently live with at least one chronic condition: survey

In light of these findings, Benefits Canada spoke to four plan members to hear their view on how their chronic conditions are impacting their experiences at work and how their conditions are covered by their benefits plans.

Diabetes

Erika Clark developed type 1 diabetes as a toddler and has many considerations so she can properly manage her condition in the workplace.

“I have a pretty typical office job with project management and people management responsibilities. In terms of activity, sitting down all day is hard on blood sugar so you have to adjust insulin for that. Also, depending on whether my blood sugar is higher or lower, it can really affect my food, my attention span and my ability to think clearly. If I’m really high or low, I tend to get frustrated very quickly and I’ll start rushing through things.”

Currently, Clark is going into the office one day a week. The commute and time in the office is much more active than working at home, she says, noting she likely needs less insulin and has to bring in more food.

“I’m really fortunate now because my benefits plan covers 100 per cent of everything I need, but this is the first time I’ve had that experience. I’ve gone through a couple of different insurance companies through my employers that have ranged from [offering] no coverage to 100 per cent coverage. Apparently, this is quite rare. Other people I talk to who have type 1 don’t have [full] coverage.”

Read: 2023 BPS coverage: Diabetes, asthma, ADHD account for high drug claims in 2022

When looking at diabetes management, there are two devices to consider, she adds. “Insulin pumps — which is what I use — have been around for a long time. They’re partly covered by the government so insurance companies are more willing to pick up the cost. For the continuous glucose monitors, there’s no provincial coverage right now unless you have an extenuating circumstance.

“I’m very fortunate, but it’s frustrating to hear people say they’d love to be on a CGM but they can’t afford it or don’t have coverage for it.”

While Canada has made great progress with enhancements to public coverage for diabetes medications and devices, many people with the condition are still facing insurmountable costs, says Glenn Thibeault, executive director of government affairs, advocacy and policy at Diabetes Canada. “Over half of people living with type 1 diabetes — [and likely type 2] — either experience costs above three per cent of their family income or fail to adhere to the treatment due to financial burdens.”

Diabetes drugs saw an increased utilization of 12.9 per cent in 2022, up from 12 per cent the previous year, says Jason Kennedy, a registered pharmacist at Telus Health, referring to the organization’s annual report. “What was interesting with diabetes was the number of claims remained unchanged at 7.7 per cent [in 2022]. What we take from that is in the [three] tiers of therapy, . . . patients are moving to the second- and third-line therapies, which are typically more costly. So the same proportion of claims are getting a higher cost per claim.”

Obesity

One of the more notable drugs to recently come to market is Ozempic, says Kennedy, which is intended to be used for diabetes management, but its positive impact on obesity is driving some prescribing activity.

Read: How plan sponsors, insurers are considering coverage of weight-loss drugs amid rising use of Ozempic

Ian Patton, director of advocacy and public engagement at Obesity Canada, knows firsthand the obstacles to accessing treatments for obesity, so he can understand the increase in demand for a drug like Ozempic.

“Last year, at the Diabetes Canada conference, there was a change in tone with how [people] were talking about diabetes and obesity. They were talking more about obesity treatment as a form of diabetes prevention. [Now we’re] looking at obesity management as an earlier approach to treating and preventing other chronic conditions.”

Patton struggled with obesity before receiving treatment and the effects had a significant impact on his ability to work. “I had issues with my energy levels, my productivity and I had a lot of health concerns that were top of mind. I had severe sleep apnea, hypertension and other issues related to obesity so all of that made it difficult to focus and be productive at work the way I wanted to be.”

Being overweight can also create mobility issues, adds Patton, so accessibility is another consideration in the workplace when it comes to obesity. “I’ve been lucky enough that most of my work is remote so I can set up my environment in a way that’s useful for me. But for overweight people who don’t have that flexibility, the work environment can be very inaccessible. Everything from the chairs in the office to the spaces in the bathroom. [If they’re not properly set up], it can make it a very unwelcoming or unsafe environment for them to access.”

As a part-time professor at York University, Patton receives a benefits plan, but it doesn’t cover any of the Health Canada-approved obesity medications. “I’d have limited coverage for things like [cognitive behavioural therapy] and working with a dietitian; however, it wouldn’t cover medically supervised treatment programs, costs associated with having bariatric surgery (pre-surgery diet, bariatric vitamins) or anything related to excess skin, which is a common issue for those of us who experience successful obesity treatment.”

Read: Evidence-based treatments key to effective obesity management

Since obesity treatments and medications aren’t covered under many plans, most people living with the condition face barriers in access to effective treatment. “They’re struggling without any real direction or guidance or appropriate means of managing the disease,” says Patton. “They’re often just being told to go lose weight and it’s not that simple. It’s a more complicated equation.

“I think there’s also clearly going to be some downstream impacts or progression of other diseases related to obesity — everything from diabetes and hypertension to cardiovascular disease and sleep apnea. There will be higher costs and impacts on plans for treating these other conditions.”

Kennedy also refers to obesity as a chronic condition that’s in flux from a coverage perspective, so any data Telus Health is looking to pull out on obesity is commingled with other conditions.

Depression

Ken Porter, national program manager at the Mood Disorders Society of Canada, has battled with depression since his late teens, so it has always been a part of his work experience.

“I remember when I first started working, it wasn’t something you ever brought up. There was never any discussion of depression or anxiety or anything like that. There was just a generalized term when you needed assistance called ‘stress leave.’ That shows the level of stigma that was associated with it back then.”

Read: Webinar coverage: Depression in the workplace and redesigning employee support

Indeed, while Porter has seen major improvements, including around workplace awareness, he notes some employers still aren’t supportive. Porter recalls an incident from a previous job where he was going through an episode of depression. His manager told him that, because his performance was slipping, maybe the job wasn’t right for someone with his condition, instead of accommodating or helping to find treatment.

“It was quite disheartening. But now I’m fortunate enough to work at Mood Disorders where we’re very open with our discussions about mental illness and depression. We encourage positive work-place habits in order to ensure employees have a positive work-life balance.”

With respect to treatment, Porter says there’s a huge gap between coverage for mental-health treatments compared to other chronic diseases. “Being able to access not just a psychologist, but any type of therapist in different provinces and territories is important.”

Mood disorders can affect individuals in a variety of different ways in the work-place, but common issues include difficulty concentrating, a decline in work performance, absenteeism and presenteeism, he notes. “We still have plenty of work to do. It’s great there are campaigns encouraging people to talk and share stories because that’s so important, but it’s not enough to just talk about it. Especially in the workplace, you need to have proactive policies that create a safe working environment for everyone.”

The coronavirus pandemic’s significant impact on people’s mental health has increased demand for mental-health programs and resources in the workplace, adds Porter, noting several studies have shown depression and other mental illnesses are the most dominant causes of disability claims.

Read: A third of Canadian workers at high mental-health risk: survey

Telus Health’s 2023 report found the increase in usage for depression medication was more common in Canadians under the age of 19, from 15.9 per cent to 19.3 per cent. “There are two ways to look at that,” says Kennedy. “One is to say there’s less stigma attached and people are [asking for] help, which is good. The other way is that the pandemic did take a toll on people’s mental health and development at really formative years in this group.”

Arthritis

Julia McNally has personally experienced episodic and permanent disabilities because of her arthritis, but she calls the short- and long-term disability coverage under her benefits plan life changing.

“When I wasn’t covered, I lost wages, it caused difficulties for my employer and the stress I experienced further hindered my ability to work.”

Along with a solid benefits plan, McNally highlights the importance of a flexible workplace for people living with arthritis and the need for employers to reasonably accommodate their employees requiring remote work or hybrid work, when possible.

“Things like medication, access to physiotherapy, psychological support, acupuncture, occupational therapy and adaptive devices covered under paramedical support all make a tremendous difference to the overall health and well-being of those of us living with arthritis.”

Arthritis is technically a group of more than 100 diseases characterized by inflammation in the joints or other parts of the body, says Siân Bevan, chief science officer at the Arthritis Society of Canada. “Arthritis is a leading cause of disability and work limitations in Canada. Employees with arthritis are twice as likely to report not participating in the workforce compared to their peers without arthritis. Significantly reduced participation is seen as young as age 35, which highlights an increased need for [prolonged] support at work.”

Read: How one patient thrives despite four decades with rheumatoid arthritis

Working with arthritis can affect an employee’s energy levels, she adds, noting the severe pain, fatigue and mood changes can impact people’s mental health as well. “Many Canadians have taken sick days and short-term disability leave because of their chronic pain or reduced their work hours. The many misconceptions about arthritis can leave individuals feeling isolated and struggling to advocate for themselves.”

A variety of drugs are often required to manage pain and other symptoms related to arthritis, adds Bevan, so the sheer number of drugs along with their high cost can create a large burden on group benefits plans. “Thankfully, there are now more innovative drugs available to treat the variety of rheumatic diseases and, with effective treatment, patients can find significant relief.

“While arthritis drugs are expensive, access to them is life changing. The right treatment at the right time can make a significant impact on a patient’s prognosis.”

Sadie Janes is an associate editor at Benefits Canada and the Canadian Investment Review.