What’s driving pressure on private drug plans today?
Canada’s drug spending is being reshaped by a small but fast-growing collection of high-impact therapies.
GLP-1 drugs, specialty biologics and treatments for chronic conditions are placing increasing pressure on private drug plans, according to the just-released 2026 Express Scripts Canada Drug Trend Report.
The report, which has been published annually since 2002, found total spending on prescription drugs rose 7.3% in 2025, with relative annual drug spend per plan member increasing to $706, up from $658 in 2024. That increase reflected both higher utilization and higher spend per claimant.
For pharmacists, the findings point to a continued shift toward more complex medication management and increased demand for patient counselling around high-cost therapies, particularly GLP-1 drugs, specialty biologics and newer chronic disease treatments.
At Express Scripts Canada's recent Health Outcomes Conference in Mississauga, Ont., speakers discussed how expanded indications, growing treatment persistence and broader use of specialty medications are reshaping benefit plan strategies. Michael Roszak, president of Express Scripts Canada said sustainability remains a foundational issue for the industry—not only in terms of affordability and access, but also ensuring positive health outcomes and a sustainable healthcare system overall.
Although specialty drugs represented just 1.1% of claims in 2025, they accounted for 31.6% of total drug spend. Specialty drug spending increased 12.5% year over year, compared with 5.2% growth for traditional drugs.
Inflammatory conditions remained the top therapeutic class by overall spend, representing 11.5% of total drug costs despite accounting for only 0.5% of claims. The report noted that high-cost biologics such as adalimumab (Humira) and infliximab (Remicade) continue to drive spending even amid ongoing biosimilar initiatives across Canada.
GLP-1 drugs remained one of the report’s dominant themes, reflecting their rapidly expanding role in both diabetes and weight management.
Semaglutide products once again ranked as the top drugs by overall spend in 2025, with spending increasing 17.7%. Meanwhile, tirzepatide emerged as another major driver of growth, with spending increasing more than 13-fold and claimant numbers rising nearly 16-fold year over year.
The report attributed rising GLP-1 use to several factors, including expanding indications, evolving clinical guidelines, growing awareness among prescribers and patients, and increasing prevalence of diabetes and obesity. Conference speakers also noted growing research interest in GLP-1s for conditions ranging from cardiovascular risk reduction to alcohol use disorder and early Alzheimer’s disease.
For pharmacists, this trend is likely to bring continued questions around eligibility, coverage and long-term therapy expectations. The report emphasized that obesity should be viewed as a chronic condition requiring ongoing management, noting that discontinuation of therapy is frequently associated with weight regain.
While the report underscored the growing impact of semaglutide products on drug spending, Health Canada approved the first generic version of semaglutide in the G7 in April 2026—a move that could further reshape the category.
Conference attendees (comprised of plan sponsors, benefits providers and other healthcare stakeholders) also heard about the growing role pharmacists are playing in navigating increasingly complex care pathways. Akhil Pandit Pautra, senior manager Clinical Services at Express Scripts Canada, noted that pharmacist prescribing has increased tremendously since 2022 following scope expansions. Erika Hatherly, strategic leader Drug Programs at iA Financial Group, added that pharmacists are increasingly being recognized as frontline providers who can support adherence, education and earlier intervention. “We know pharmacists are that frontline provider of care to help with adherence,” she said. “Let’s see how we can partner more effectively so we can be there when future opportunities come.”
Beyond diabetes and inflammatory conditions, the report identified significant spending growth in skin condition therapies, oncology drugs and newer lipid-lowering agents—further underscoring the increasingly specialized and high-cost nature of pharmacy care.
