Attention deficit hyperactivity disorder is a neurodevelopmental disorder, affecting up to nine per cent of children and five per cent of adults, said Marie-Hélène Dugal, manager of pharmacy benefit strategy at Medavie Blue Cross, during Benefits Canada’s 2024 Face to Face Drug Plan Management Forum.
Diagnosis rates have increased among women and become more common in adulthood, she said, and the subsequent implications for plan sponsors include drug costs, treatment access, and employee well-being.
“The number of claimants and [those] claiming for an ADHD drug has risen 76 per cent since before the pandemic,” said Dugal, noting the growth is most pronounced in adults aged 25 to 60, with women outpacing men in ADHD drug claims for the first time.
Read: How employers can help employees with ADHD be engaged, productive
There has also been an increase in the number of certificates where both an adult and a child are claiming for ADHD medications, she noted, which suggests that, “once the parent learns a little bit more about what the condition can look like, they recognize some of these symptoms in themselves.”
The increase in ADHD diagnoses and claims presents a dual reality of improved diagnosis and care, but also increases the pressure on drug plans, said Dugal. Growing claims volume point to potentially earlier diagnosis, better access to treatment and improved symptom management; however, improved care also leads to mounting drug costs.
“Sustainable plan management is always important to continue to balance plan costs and derive the most value from the dollars that are invested into the plan.”
With tiered formularies, ADHD medications can be divided into tiers, assigning different copay levels to encourage cost-effective choices without limiting access, she said, noting step therapy encourages patients to explore effective, lower-cost options before advancing to more expensive treatments.
Read: How plan sponsors can improve employee health outcomes while optimizing drug plan spend
“A few of the most commonly claimed ADHD drugs have gone generic in the past year or two,” said Dugal, adding plan designs that encourage the use of generics can ease cost pressures while ensuring treatment effectiveness.
Effective ADHD treatment isn’t just about managing drug plan costs, she noted. Providing support for employees with ADHD — through comprehensive drug plans and treatments like cognitive behavioural therapy — can improve productivity, reduce absenteeism and create a more inclusive work environment.
ADHD is a growing area of focus, both medically and in terms of its workplace impact. “Supporting employees and their families with ADHD can help employers achieve their goals in terms of diversity, equity and inclusion, as well as having a healthier and more productive workforce.”
Read more coverage of the 2024 Face to Face Drug Plan Management Forum.