Two benefit consulting firms have reported on the results of their surveys on Flex plans. Hewitt’s “Flexible benefits in Canada” survey reports that 47 per cent of employers offer true flexible benefit plans. (True flex plans are those that offer choice in the benefit mix, not just a bolted-on Health Spending Account). Mercer's survey, on the other hand, pegs the flex share at only 14 per cent. (This is based on a global study, and Mercer’s does not provide a breakdown for Canada).

Both studies anticipate a take-up rate for flex in the near future of about one-third. We have no way to know which is closer to the truth for Canada, but since the Hewitt study was unique to Canada, it is probably safe to assume that their numbers are a better reflection of the Canadian market.

While the two studies are inconclusive about the actual penetration of flex plans, it seems clear that they are growing, and we will see more of them. And this is not good news for market access to pharmaceuticals.

Ostensibly about employee choice, the authors of both studies acknowledge that the strategy had helped employers reduce cost. Employee choice about drug coverage always involves employees having to trade off open access at reasonable cost, against taking a chance they will not incur heavy drug expenses so they can spend more of their benefit allowance on other components of the package. This means higher cost-sharing or more limited formularies. And if employers admit that flex is actually driving costs down, this has to be because with flex plans they can pay less for the drug benefit.