The missing claimants of 2020: Who  went without claims in Canada during the first year of the COVID-19 pandemic  and what does it mean for public and private insurers?

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Étienne Gaudette, PhD, and Yvonne Zhang, MA

Introduction

Context

The COVID-19 pandemic and the public health initiatives to contain it produced multiple shifts in insurance plan enrollment and claims made by enrollees in 2020. Both public insurance plans and private insurance plans were impacted by these shifts.

Objective

This study aims to draw attention to the sharp decline in claimants observed in 2020 in Canada, and to examine whether the “missing claimants” of 2020 could impact drug claims and spending for years to come.

Approach

The analysis focuses on annual data from public and private drug plans between 2015 and 2020, investigating the changes in the number of claimants in 2020 relative to previous years by public/private plan, age group, and spending level.

It also documents the therapeutic classes that saw the greatest declines in the number of claims filed in 2020.

Data

Public insurance plans: Annual aggregates from publicly financed drug benefit programs affiliated were compiled with the National Prescription Drug Utilization Information System (NPDUIS) database, which represent approximately 7 million publicly insured active beneficiaries. Public drug plans from British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, New Brunswick, Nova Scotia, Prince Edward Island, and Newfoundland were included in the analysis.

Private insurance plan data: Aggregated annual data from the IQVIA Private Drug Plan database were used for the analysis. This database houses adjudicated prescription claim-level data collected from a large sample of Canadian pay-direct private drug plans representing all provinces and territories, and was estimated by IQVIA to represent 85.7% of the Canadian private pay direct insurance market.

Definitions: Claimants are individuals with at least one prescription drug claim accepted for reimbursement during a given year. Public insurance plan annual data were aggregated at fiscal years (Apr. to Mar.), while private insurance plan data were available at calendar years (Jan. to Dec.). Therapeutic classes are defined based on the second level of the World Health Organization’s Anatomical Therapeutic Chemical classification system.

Exclusions: Because design changes impacted public plan eligibility of Ontario claimants under 25 during the study period,Footnote 1 they were excluded from Figures 1 and 2. For the same reason, Ontario claimants by spending level and Ontario claims were excluded from Figures 3 and 4, respectively, since they were not disaggregated by age group for private insurance plans and were impacted by the eligibility changes. Claimants with an unknown age group were excluded from Figure 2. Claims for vaccines were excluded from public insurance plan data in all analyses because of differences in their reporting by jurisdiction.

Results

The 2020 decline in claimants was atypical

Figure 1: Number of Canadian public and private drug plan claimants, 2015 to 2020 Figure 1
Figure description

This stacked bar graph provides the annual number of Canadian private and public drug plan claimants, from 2015 to 2020. The results highlight the decline of claimants in both categories between 2019 and 2020. There was a 1.7% (90,000) decline in publicly insured claimants between 2019 and 2020 and a 6.6% (830,000) decline of privately insured claimants during the same timeframe.

Year Number of publicly insured claimants, millions Number of privately insured claimants, millions Total number of claimants, millions

2015

4.9

11.1

16.0

2016

5.0

11.4

16.4

2017

5.1

11.9

17.0

2018

5.2

12.3

17.5

2019

5.4

12.6

18.0

2020

5.3

11.8

17.1

Who were the missing claimants?

Figure 2: Claimants by age group, 2015 to 2020 Figure 2
Figure description

This two-part line graph showcases the change in the number of Canadian public and private drug plan claimants by age group from 2015 to 2020. The three age groups listed are claimants younger than 25 years old, claimants aged 25 to 64, and claimants aged 65 and older. The analysis is completed separately for publicly and privately insured claimants.

Age group 2015 2016 2017 2018 2019 2020 Total change from 2019 to 2020 Percent change from 2019 to 2020

Publicly insured claimants

Less than 25

243,668

239,397

225,723

225,120

233,446

184,852

-48,600

-20.8%

25 to 64

1.3 million

1.3 million

1.3 million

1.3 million

1.3 million

1.2 million

-94,400

-7%

65 and older

3.4 million

3.4 million

3.5 million

3.7 million

3.8 million

3.9 million

53,200

1.4%

Privately insured claimants

Less than 25

1.9 million

2.0 million

2.0 million

2.0 million

2.1 million

1.7 million

-307,000

-14.9%

25 to 64

8.5 million

8.7 million

9.0 million

9.2 million

9.5 million

8.9 million

-578,600

-6.1%

65 and older

927,860

981,667000

1.1 million

1.2 million

1.3 million

1.3 million

32,200

2.5%

 

Figure 3: Claimants by spending level, 2015 to 2020 Figure 3
Figure description

This two-part line graph showcases the change in the number of Canadian private and public drug plan claimants by spending level from 2015 to 2020. The spending levels listed are less than $5000, $5000 to $9,999, and over $10,000. The two sections of the line graph compare the same spending levels between the publicly and privately insured claimants.

Spending level 2015 2016 2017 2018 2019 2020 Total change from 2019 to 2020 Percent change from 2019 to 2020

Publicly insured claimants

Less than $5,000

2.1 million

2.1 million

2.1 million

2.1 million

2.2 million

2.1 million

-70,900

-3.2%

$5,000-$9,999

56,104

54,659

56,757

53,422

58,653

66,287

7,600

13%

$10,000 and over

47,899

49,969

55,686

62,598

67,449

71,976

4,500

6.7%

Privately insured claimants

Less than $5,000

7.1 million

7.2 million

7.6 million

7.8 million

8.0 million

7.5 million

-553,500

-6.9%

$5,000-$9,999

61,157

63,840

68,056

70,072

77,732

89,094

11,400

14.7%

$10,000 and over

48,721

52,940

57,820

62,277

68,886

76,721

7,800

11.3%

Some therapeutic classes saw important declines in claims

Figure 4: Top five therapeutic classes with the greatest decline in claims for public and private insurers, 2019 to 2020 Figure 4

Note: Only classes with 10,000+ annual claims on average during the pre-pandemic (2015–2019) period were considered for the figure. All declines shown were greater than 1.96 times the standard deviation observed during the pre-pandemic period.

Figure description

This two-part bar graph showcases the top five therapeutic classes that experienced the greatest decline in claims between 2019 to 2020, for both public and private insurers. Only classes with more than 10,000 annual claims on average during the pre-pandemic period (2015–2019) were considered for the figure. All declines shown were greater than 1.96 times the standard deviation observed during the pre-pandemic period.

Public insurers

Therapeutic class Percent change between 2019 and 2020

Ectoparasiticides

-21.8%

Antibacterials for systemic use

-21.2%

Stomatologicals, mouth preparations, medicinal fentifrices, etc.

-16.6%

Antimycobacterials

-15.2%

Antibiotics and chemotherapeutics for dermatological use

-9.6%

Private insurers

Therapeutic class Percent change between 2019 and 2020

Cough and cold preparations

-61.4%

Ectoparasiticides

-45.6%

Antiprotozoals

-31.3%

Antibacterials for systemic use

-29.1%

Vaccines

-26.2%

Conclusions

With the onset of the COVID-19 pandemic, nearly one million fewer Canadians filed drug insurance claims in 2020 compared to 2019. A decline in claimants was found in both public and private insurance plans.

Groups of claimants showing declines were below retirement age and with lower spending levels. The therapeutic classes which saw the greatest declines in claims were associated with acute rather than chronic diseases.

Claimants are expected to increase as public health restrictions are gradually lifted and non-COVID acute needs return to pre-pandemic levels.

Notes

Note 1

Government of Ontario. (2017, April 27) Ontario to Provide Free Prescription Drugs for Children and Youth [Press release]. Retrieved from https://news.ontario.ca/en/release/44530/ontario-to-provide-free-prescription-drugs-for-children-and-youth.

Return to footnote 1 referrer

Limitations

All analyses performed were observational and cannot inform about the causal effect
of the COVID-19 pandemic. Two public insurance plans were not included in the analysis: the Régie de l’Assurance Maladie du Québec is not included in the NPDUIS data and data
for the Non-Insured Health Benefits program were not available for fiscal year 2020-21.

No data was available to study public and private insurance plan enrollees during the period. For that reason, the analyses could not distinguish between changes in claimants and claims due to eligibility/enrollment (e.g., because of job loss) and those attributable to utilization.

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