The Ontario Drug Benefit (ODB) covers more than 4,400 prescription drug products. Currently, it has been available to seniors (age 65 or older) and for others who meet specific criteria such as:
-living in a long-term care home or a home for special care or enrolled in Home Care,
-Ontario Disability Support Program, or the
-Trillium Drug Program.
The Ontario Drug Program (ODP) is for residents of Ontario with a valid health card. An eligible prescription needs to be filled in an Ontario-based pharmacy and it won’t cover prescription drugs purchased outside the province, drugs not listed on the ODB or not approved for the Exceptional Access Program. The ODB Formulary is updated monthly. It includes brand name and generic drugs.
The ODB also helps Ontarians pay for:
• allergy shots and Epipen (used in response to severe allergic reaction)
• some products used in monitoring and testing for diabetes
• some prescribed over-the-counter drugs under specific circumstances (e.g. Ibuprofen 200mg, Ferrous sulphate 300)
• some nutrition products
• some drugs used in treatment of HIV/AIDS
• some drugs used in palliative care
At present, the ODP ?";covers approximately 3 million seniors and 900,000 families on social assistance.
As of January 1, 2018, Pharmacare for children and youth will be eligible for the ODB. This new program makes the Ontario government first payor for these 4,400 ODB prescription drug products. This is an additional step toward complete provincial coverage.
Eliminating cost and red tape.
As of January 1, 2018, children or adults age 24 or younger no longer have to go through their own or their parent’s private coverage first. With the Ontario government assuming first payor responsibility, equal access to meditation is available to all who meet the eligibility criteria without adding time or additional cost. As the program is free for eligible Ontarians, recipients aren’t responsible for co-payment or dispensary fees.
What could this mean for plan sponsors?
Will these changes result in financial relief for plan sponsors? It depends on the plan sponsor’s funding arrangement, and the demographic make-up of their workforce with eligible dependents. Insured plans may not have exposure to the same type of cost shift plan sponsors with an Administrative Services Only (ASO) arrangement may experience.
With the provincial government taking on the first payor for young Ontarians, plan sponsors may look at the first payor change as an opportunity to review their group benefit health plan designs. Will they consider implementing drug caps to further reduce drug plan costs? Perhaps.
January 2018 represents a time of transition when shifting the approvals from private payor to public make signal some bumps in the road. Although nothing has yet been confirmed, there needs to be a grace period and process to ensure that already approved private payor coverage is moved over seamlessly to the Ontario Drug Program. Allowing for an automatic coordination of benefits between Trillium and private payers also would be a welcome system change.
While there is more work to be done and questions to be answered about this important provincial prescription drug benefit change, signals are pointing in a positive direction where Ontario youth have the ability to feel more protected when they need it.
These continue to be exciting times of change for the benefits industry. Our team is well positioned and ready to support you through change. Please contact us. We’re here to help so that you can focus on what you do best.
Imagine that you were traveling from one desert town to another and needed to carry water with you along the way, but the bucket you used to transport the water had holes in it. Since water was such a precious resource, you'd likely ensure that you plugged the holes in the bucket immediately or replaced it with a new bucket. You wouldn't want to risk the unnecessary loss of water by not addressing the leaks.
There's a hole in my benefits bucket.
Now picture a scenario where the bucket is your group benefits plan and the holes in the bucket are fraud and abuse that needlessly drain dollars from your healthcare spend. According to the Canadian Health Care Anti-fraud Association, the cost of healthcare in Canada rose to $215 billion in 2014 and approximately $2 billion was lost to fraud and abuse. That is one leaky bucket! Plan sponsors continually to try to manage the mounting costs of prescription drugs and other factors that influence claims expenses, but the question remains -- are they doing enough to plug the holes caused by healthcare fraud and abuse? Even the most creative benefit plan cost containment measures are challenged by the effects of fraud and abuse. The good news is there are several ways to plug the holes in the bucket and prevent leakage.
Fraud and Abuse defined.
Fraud in healthcare is defined as deliberate deception for financial gain at the expense of a group benefits plan where abuse could be considered the unnecessary use of plan dollars driven by a sense of entitlement. Where fraud is illegal, abuse doesn't usually dictate criminal intent. Rather it is often motivated without awareness of it being highly unethical or possibly criminal. An example of abuse occurs when plan members and/or their eligible dependents use their benefits to the annual maximum even though the services they receive are deemed not medically necessary. Fraud, on the other hand, involves a plan member or a healthcare provider or both, knowingly falsifying a claim or lying about services provided or received.
Plan Sponsors put pressure on service providers.
Rapidly changing technological advancements create ease of service, but also growing opportunities for healthcare fraud. As financial institutions, like the major banks, dial up their fraud prevention measures, those who look to commit fraud are instead turning their attention to the healthcare industry. As a result, plan sponsors are putting more pressure on their service providers to help them plug holes in their group benefits bucket created by more sophisticated healthcare fraud techniques.
What are service providers doing to prevent healthcare fraud?
While technology has been used to create fraud, it can also be used to prevent it. Service providers place greater emphasis on healthcare fraud prevention measures. From pre-payment to post-payment verification, random checking of submitted claims, hospital claim audits and delisting of service providers, big data is used to analyze claim patterns and feature anomalies commonly associated with fraud and abuse.
Plan Sponsors play a key role in prevention.
As service providers continue to investigate new ways to protect their plan sponsors from fraud and abuse, there are steps employers can take to fortify the walls of their benefits bucket. Plan design is an important consideration when addressing fraud prevention. Introducing features such as a Health Spending Account, deductibles and copays as well as reasonable coverage limits are some, but not all, of the steps that can be taken to limit the potential for fraud and abuse-related plan leakage.
Educate to prevent.
Plan members may unwittingly drive up claims costs through acts of healthcare abuse and waste. They also may not realize that some healthcare providers commit fraud and that their own actions unknowingly enabled a fraudulent activity. The more plan members are informed and educated about the negative consequences of healthcare fraud and abuse, the more likely they will be to do their part to help prevent it.
Additionally, plan members and their dependents should be educated about the different ways to report fraud. It should be easy for them to access a phone number, email address or website in order to reach an anti-fraud resource either internal to their organization, via their service provider or an industry contact such as the Canadian Health Care Anti-fraud Association at www.chcaa.org.
Through a combination of tactics and efforts by various parties including the plan member, plan sponsor and service provider, the effects of fraud and abuse can be minimized. With decades of experience in the benefits industry, we bring our knowledge of fraud prevention and plan design best practices to work for you. Together, we can address the risk of healthcare fraud and abuse and make sure your bucket avoids developing preventable leaks. Please contact us. We're here to help so that you can focus on what you do best.
You've likely seen it, the commerical for a prescription medication that depicts a person living a happy and careful free life now that they are taking the featured medication. Then just at the commerical ends, a long and frightening list of potential side effects is read aloud by a voice-over actor. The result -- a growing fear of medication side effects. In fact, this fear of side effects is one of the primary reasons people don't adhere to the prescription medication protocol prescribed them.
Why aren't you taking your pills?
As researchers begin to take a closer look at the issue of medication non-adherence, the reasons bubbling to the surface for not taking or finishing their pills includes
1) symptoms disappear and the patient stops taking the medication
2) can't afford the medicine
3) just forgot to take them
4) instructions for taking the medication are too complicated (taking it with food or after a meal or more than once a day at different times)
5) difficult to get the "child proof" cap off the medication
6) experiencing side effects
7) patient motivators and triggers
Whatever the reason or combination of reasons, medication non-adherence is a serious issue. The findings in a recently released study by the Canadian Association for Retired Persons (CARP) and Shoppers Drug Mart revealed that "50% of Canadians with chronic diseases are non-adherent to their medications" and that one in three prescriptions go unfilled, and even when then are filled, they are not taken.
The survey says...
Medication non-adherence costs the patient in terms of overall health and recovery, and it also costs our public health care system. This same CARP and Shopper's survey reported that "69% of medication-related hospitalizations were due to non-adherence to prescription protocols." The associated cost to Canada is estimated between $7 and $9 billion annually. Additionally, the survey found that 50% of people with chronic diseases didn't follow the prescription protocol outlined by their doctor thereby not even giving the medication a chance at being effective.
Aside from the impact to the patient and to our public health care system, when an employee is medically non-adherent, they cost their employer through increased absenteeism, disability claims and increased extended health claims; especially for high cost drugs.
What can be done to remedy the situation?
Employers can help employees understand what information and support is available to them as patients.
- Inform employees about the potential health implications of non-adherence.
- Share with them about the convenience of mail-order pharmacies to support those with chronic conditions requiring maintenance medications.
- Provide information about ways pharmacists can help including consultations and follow-up calls to remind them to pick up refills. Additionally, pharmacists don't require an appointment in order for a consultation to happen, particularly if there are concerns about possible side effects.
- Inform employees of pharmacies that provide medication organization packs, pill cards for taking multiple medications, and locations for 24 hour pharmacies.
The issue of medication non-adherence is one that can be addressed through education, awareness and perseverence. The more informed you are, the more opportunity you have to effect positive outcomes. We invite you to contact us to discuss available insurer-generated data to identify opportunities to promote adherence, reduce absenteeism and gain productivity. We're here to help so you can focus on what you do best.
The 2016 Sanofi Canada Healthcare survey featured the responses and preferences of plan members across Canada. While prescription drugs remain top of the list in terms of usage and cost, paramedical services landed securely in second place. What has been surprising is the trend toward younger generations' looking to holistic alternative therapies and increasingly tapping into the use of paramedical services such as massage therapy.
Paramedical services are defined as "services provided by professionals who aren't covered by the public health system." Paramedical practitioners include: chiropractic, massage therapy, naturopathy, acupuncture and osteopathy.
For years now, cost control tactics for group insurance have rested squarely in the corner of prescription drugs. With costs containment strategies aimed at slowing the rapidity of drug spend, there hasn't been as much emphasis placed on what some may consider more low hanging fruit options for addressing unnecessary and expensive group plan extended health coverage.
The factors applying more pressure on this topic are affected by the behaviours of four primary stakeholders: the insurer, the plan sponsor, the plan member and the paramedical practitioner.
Insurers naturally look to support their clients in addressing areas where the biggest ticket spend categories punch their way forward as heavy weight champs. It requires experienced and highly specialized talent to navigate predictions for consumer spend, trends in the pharmaceutical industry and client tolerance thresholds. If plan sponsors don't raise the flag that there are other areas to focus on -- with as much diligence-- the emphasis may well remain fixed on pharma.
Plan sponsors benefit from creating or revisiting their benefits philosophy to avoid difficult decisions and conversations pertaining to what benefits are covered and why. In situations where companies feel the need to tighten their belts and are looking for any possible way to reduce costs, group benefits plan design may become an employee engagement danger zone if not handled strategically. One way to consider keeping the flexibility of paramedical services such as massage therapy involves Health Care Spending Accounts (HCSA). By including a cap on the amount allocated per plan member, budgets can be managed more consistently and with greater predictably.
Plan members value their benefits, but don't always connect the dots between usage and cost. Some hold the belief that since they have the paramedical benefit, they are entitled to using it whether or not there is an actual medical need. Helping plan members understand that increased usage drives the cost of providing the benefit is another actionable that both the insurer and the plan sponsor shouldn't lose sight of. Member education must always remain in vogue for employee benefits and incorporating trending communication methods, such as digital media, allows for creative ways to more accessibly reach this audience.
Paramedical practitioners have variations in their required training hours, code of ethics and accreditation associations. Their behaviours drive perception of professional standards and fraud in health benefits. Ensuring the need to operate with the highest ethical standards and requiring continued professional development and training hours will be invaluable in a constantly changed and increasingly complex working environment such as the spa industry where a predominance of paramedical practitioners such as massage therapists work.
While there are no quick fixes or simple solutions to the complexity of controlling costs, the need to remain focused on usage outside of prescription drug spend is real. If you're looking to more fully address these issues, I invite you to contact us. We have decades of experience and deep industry knowledge. Let us put that knowledge to work for you so that you can continue to focus on what you do best.
March is also know as Pharmacist Awareness Month (PAM) and it creates an opportunity for the pharmacist community to help educate Canadians on the contributions that this profession makes in the delivery of health care.
During the course of the last decade, there has been a significant shift and a much greater emphasis on expanding the scope of the pharmacist's practice and the services they deliver. Perhaps some of this has to do with helping consumers understand prescription costs and dispensing fees and how and why they vary among pharmacies.
This month is a great time to remind employees of the value of being smart consumers particularly when it comes to prescription drugs and their respective group insurance coverage.
Here are my tips to promote empowering employees with knowledge to save them money while enhancing the experience they have at their local pharmacy.
1. Understand your benefits coverage and how it integrates with government sponsored programs. In Ontario, there is the Ontario Drug Benefits (for eligible Ontarians over age 65) There also is the Trillium Drug Program for eligible Ontarians who have high prescription drug costs relative to their household income. Most other provinces have a program to help Canadians save on prescription costs.
Encourage employees to check out government websites as well as information about their group benefits program. Make a checklist available online as an easy-to-access resource. A trivia quiz or a one page fact sheet may prove invaluable to address frequently asked questions such as:
1) Do I submit a prescription receipt for reimbursement or does the pharmacist bill the insurance provider directly?
2) Is the a deductible (amount the employee pays out of pocket before the rest of the cost of the prescription is covered) and if so, what is the amount/percentage?
3) What is the maximum dollar amount that can be claimed in the plan year and is there a lifetime maximum of coverage?
4) I have children -- when does their coverage end?
5) What is a dispensing fee?
6) What is the difference between the prescription cost and the dispensing fee?
7) What is the difference between generic and name brand drugs?
2. Be a smart consumer and compare dispensing fees. Differences in pharmacist dispensing fees can vary greatly. Encourage employees to shop around for the best service and best price. Dispensing fee lists for pharmacies are available online. A dispensing fee is the pharmacist's charge for their time to stock medication, dispense the drug product, talk about treatment with the customer, maintain and check medication records to avoid drug interactions, provide drug information to their client's attending physician and provide other specialty services like blood pressure checks.
It helps to provide examples that employees can relate to. For example, a dispensing fee could be compared to the shipping fee a consumer pays for an online purchase. Most people shop around for the lowest cost shipping or free shipping if possible. The same premise holds true when shopping for a pharmacy service.
While some provinces regulate the fee, most are set by each retailer and dispensing fees vary. Lower cost providers tend to be closely linked to big box stores like Costco (around $5.00) and Walmart with higher prices at retailers such as Shoppers Drug Mart and Rexall Pharmacy (around $12). Also, many retailers offer points programs such as Air Miles or their own in-house program.
3. Saving on refills. Remind employees that a dispensing fee is charged PER prescription. Filling a three month prescription at once is less costly than filling three prescriptions at the same time. Remind employees of the group insurance provision and if the plan covers up to a maximum (i.e. 3 months of a prescription at a time). Then, provide employees with examples to drive home the point such as:
(Prescription cost is $8.02/month + $9.99 dispensing fee) x 3 refills = $54.03 a year
(3 months of a prescription $24.06 + $9.99 dispensing fee) x 3 refills = $34.05 a year
4. Promote generic drugs. Perhaps there is a bit of a stigma or a concern about shopping for a generic product versus a name brand where people believe there is a significant difference in quality. Where they might have a greater appetite to consider this at the grocery store, but they are far more reluctant to choose generic if they believe there is a quality difference with a prescription drug purchase. Educating employees that the generic version of a drug generally costs about 50 percent less than the name brand version AND the quality standards are the same in that generic drugs MUST contain the same amount of medicinal ingredient as their name brand counterparts.
Knowledge is power and helping to educate employees and remind them of ways to save and have a better experience at the pharmacy creates a win/win/win situation for the consumer, the employer and the pharmacist. For more information about prescription drug coverage and the optimal group benefits program to meet your needs, please contact us. We're here to help so you can focus on what you do best.
Are sideburns in or out? Are skinny jeans still in fashion or not? These are not topics that preoccupy my thoughts, but I do regularly contemplate trends when it comes to the benefits industry. It is an area of importance for my practice and particularly for how I consult with my clients.
Strategy involves being aware of and remaining ahead of the curve. With that said, this post relates specifically to what I consider to be some of the top trending topics in the realm of Canadian employee benefits. Since my first post in October 2012, I've blogged about each of these 5 areas on more than one occasion. For ease of reference, I've included a link to some of my past posts within each trending topic.
1) Employee Wellness: increasingly, employers are looking for ways to dial up productivity and engagement levels and in so doing, they recognize the need to consider the employee from a holistic perspective. More and more companies are embracing wellness programs and determining the baseline metrics to establish success criteria. Whether it is something as simple as supplementing worksite vending machines with healthier food options or hosting wellness fairs, it is time to consider what wellness programs can do to add to the overall staff experience while driving success for better employee health outcomes.
2) Mental Health: Whether via mega employers like Bell Canada through their mental health anti-stigna "Lets Talk" campaign, or Great West Life's Centre for Mental Health in the Workplace, the focus is consistent because the statistics are staggering -- mental health issues are a real concern in Canada. According to the CMHA, 20 percent of Canadians will personally experience a mental illness in their lifetime and approximately 8 percent of adults will experience major depression at some time in their lives.
Back in January 2015, I wrote about mental health indicators for Canada and how they influence group benefit plans. At that time, a national commission had just been released regarding a compressive study on the state of Canada's mental health. Mental health claims represent approximately 12 percent of disability claims according to CMHA. Many employers see dips in productivity well before a disability claim surfaces through sporadic absenteeism, workplace safety, and more regular issues of lack of focus and emotional reactivity among colleagues.
3) Prescription Drugs: Weighing in at 13 percent of total health expenditures in Canada, prescription drugs have been an area of focus for a long time. Costs are high especially when specialty drugs factor in the the equation -- just as I wrote about with new hepatitis C short term treatments. Cost management trends include ways to mitigate these risks through pay-direct cards, mandatory generic substitution, dispensing fee caps, preferred pharmacy networks and prior authorization.
4) Financial Literacy: November is financial literacy month and with it comes many reminders of free online tools available to help Canadians manage their money and save for retirement. These reminders are important as employees continue to experience stress due to financial woes. Many Canadian struggle to make optimal financial decisions and don't have more than $2000 in an emergency fund. When employees are stressed about their finances, it impacts their ability to focus and be productive at work. Increasingly, employers are placing more emphasis on providing financial educational opportunities as part of wellness programs.
5) Benefits Communications: Whether designing a benefits plan or making tweaks to an existing arrangement, the need for excellence in benefits communications is ever present. Driving up plan member pension participation rates or gaining appreciation for the value of the total compensation package, employers continue to seek ways to catch employee's attention.
Considering the demographic changes and the life cycle of the workers moving along the employment continuum are also areas of focus for our firm as we address trends with our clients. As Wayne Gretzky said, "A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be." We believe the same concept holds through in the benefits industry. We invite you to contact us, we're watching where the benefits 'puck' is going to be so that you can continue to focus on what you do best.
When people think about hepatitis C, there might be a tendency to imagine people in developing countries contracting this virus as a result of unsterilized needles.
Surprisingly, it is also a major health concern in Canada largely due to injection drug use. It is a disease that carries a slow progression where someone who had a blood transfusion or got a tattoo prior to 1992 could fall victim to it. Approximately 150-200 million people worldwide have hepatitis C. In Canada, there are an estimated 242,500 individuals infected with the virus.
What is hepatitis C? It is an infectious disease that attacks the liver. The hepatitis C virus (HCV) creates an infection that is slow moving and people who contract it might seem asymptomatic for years before it starts to scar the liver — leading to cirrhosis — followed by liver failure, liver cancer and related complications. The virus is treated with medication and approximately 50-80 percent of those treated are cured. To date, there is no vaccine against this virus.
From an employer perspective, hepatitis C should be something to watch for on the benefit plan horizon as HCV medications like Holkira Pak, Sovaldi and Harvoni infuse the market. These medications are pricey and depending on the duration of treatment, may cost somewhere in the $150,000 range. For example, a single 12-week treatment may cost around $80,000. Prior to the introduction of these new short term treatment specialty drugs, one hepatitis C treatment might cost $17,000. It is worth mention that these new drugs help prevent the need for liver transplants and as a result are a sound investment from that perspective alone.
Ontario, Prince Edward Island, Quebec, all had these new generation hepatitis C drugs on their formularies. Recently, the provinces of Saskatchewan, British Columbia and Manitoba announced they would follow suit.
As an experienced benefits advisor, my team and I monitor the introduction of any new and costly drugs that may affect private group benefit plans. We work with service providers to implement and positively influence cost management mechanisms. For example, we know and communicate with our clients what group insurance carriers offer pre-approvals or prior authorizations for speciality drugs such as Sovaldi.
Increasingly there will be more new and expensive drug treatments flooding the market and we want to help you mitigate your financial exposure all while offering your employees an arrangement that allows them to live healthier lives.
I invite you to contact us to learn more about this topic and to help you manage your group benefits drug spend. We’re here to help so that you can focus on what you do best.
So much of what we hear in the news is about making sure we stay ahead of the curve and that we innovate. Whether personally or professionally, the pressure is real and many of us feel it expressed in the articles we read, in the shows we watch and from the people we meet.
Since drug plans make up between 60 to 80 percent of the cost of private health care benefit costs, there is no wonder so much focus is given to innovation in the arena of drug plan management.
This can be a complex topic of discussion, and in many cases the challenge involves communication - with a call to action that invokes the need for plan members to become smart healthcare consumers. There is great emphasis placed on the top 10 high-cost drugs and the associated impact to the plan. Should that be the main point of concern? We give great credence to generic drug plan substitution and managed formularies - all innovative methods to help manage the plans, but sometimes innovation takes the form of focusing on areas we have not paid much attention to previously.
There are obvious cost drivers as well as other triggers that seem to hover below the radar. Medication non-adherence is one of these 'below the radar' drug plan cost drivers. Non-adherence occurs when plan members don't follow the recommendation of a health care provider regarding the prescription medication or don't follow a recommended diet or lifestyle change.
When a plan member doesn't adhere, the cost to the plan is two fold: increased drug costs and a negative impact on the plan member's health. In a previous blog post, I addressed the topic of complex chronic diseases and the role it plays in benefit plan management. What happens when a plan member with a complex chronic disease does not adhere to his medication? In Green Shield Canada's 2012 Drug Study, almost 40 percent of plan members with high blood pressure are non-adherent. The same goes for plan members with high cholesterol. What is the cost to the plan? Non-adherence in these two examples alone cost a plan 3.5 times as much as those without the condition.
As the workforce ages and Baby Boomers (born between 1946 and 1964) face headlong into the path of retirement, we'll experience an increase in chronic diseases. As per a U.S. National Medical Expenditure Panel Survey, the number of people with chronic diseases is projected to reach 171 million by the year 2030. The potential cost to the plan becomes easier to see as the expected numbers of plan members with a chronic disease increase exponentially.
In the world of benefit plan management, we are challenged to address this situation from a holistic approach. For a plan member who is trying to change to a healthier lifestyle, should it just be the pharmacist's duty to support the change or should it be all the players involved as part of a new healthy lifestyle entourage? What about the Employee Assistance Provider or the Case Manager helping the plan member successfully and safely stay at work?
Innovation is key to helping proactively manage drug plan costs, but there are other areas to explore - medication non-adherence and the role of all stakeholders in the drug delivery model are important components to ensuring the health of the plan member as well as the health of the benefits plan.
Staying ahead of the curve in the world of drug plan management can be complex. Please contact us to discuss this and other topics related to your benefits plan. We are here to help so that you can focus on what you do best.
There have been dramatic increases in the number of people with chronic illness and these numbers are projected to reach 171 million by the year 2030 according to a U.S. National Medical Expenditure Panel Survey.
From prescription drug costs to the use of physiotherapy, massage therapy and counseling services, it is more likely for plan members with chronic conditions to access the group benefits available to them.
Chronic, complex diseases are conditions such as multiple sclerosis, cancer or rheumatoid arthritis often require the support of various types of health care providers or facilities. Plan members or their eligible dependents with complex chronic diseases have unique needs and in some instances, functional limitations. Health service providers are called upon to work closing with their patients to help address the complexity of managing the condition.
While new speciality drugs or biologics improve the quality of life for plan members with chronic and complex diseases, there is an impact to the increasing costs of private health benefit plans. It will be an interesting and important time to monitor the outcomes of fully insured group plan renewals impacted by the Canadian Life and Health Insurance Association Inc. (CLHIA) drug pooling agreement that was launched January 1, 2013.
The increase in health care costs has led to a variety of strategies to manage cost. Plan sponsors and service providers continue to look for engaging ways to communicate and collaborate with plan members. Communications targeting ways for plan members with chronic diseases to be smart healthcare consumers shouldn’t be undervalued. There are simple tips for plan sponsors to share with plan members who live with a chronic disease:
* learn about co-pays for generic, brand and formulary drug plans to avoid additional out-of-pocket costs;
* consider generics if the attending physician believes it to be safe;
* adhere to recommended prescription dosage. Those who self medicate or don’t renew medication on time can find themselves with a host of additional health-related complexities;
* consider consolidating with one pharmacy for all the prescription drug claims. Pharmacist will ensure that the possibility of prescribing for duplication or negative interactions is avoided;
* explore the option of Mail Order refills for chronic conditions requiring maintenance medications such as cholesterol-lowering or blood-pressure drugs. If available within the group benefits plan, this service offers convenience as well as lower dispensing fees.
For more information about ways to enhance your group plan’s effectiveness and manage benefit plan costs, please contact us. We’re here to help so that you can focus on what you do best.
Imagine if you were an employer who was told that in the next few years your group benefit drug costs would double as a percentage of payroll. What would you do?
Many employers wonder about the post recessionary impact of prescription drug spend and the financial impact it will have on their bottom line.
Mercer's 2011 survey of Canadian private drug plan looked at responses from employers ranging from under 100 employees to as many as 20,000. With a median size of 600 employees, 70 percent of respondents said that they pay at least 80 percent of drug costs, and with that, a large number of them still cover over-the-counter drugs. Increasingly, managing the risk of a group benefits plan is top of mind for plan sponsors.
High-cost specialty drugs are not going to stop being introduced into the consumer marketplace. They are needed and create healthy outcomes for many patients. However, it is important to continue diligently looking at ways to effectively and efficiently manage drug plans.
Here are a some tips for plan sponsors to consider:
Keeping an eye on drug plan design considerations is something my team does well. Call or email us to design or modify your plan. We're here to help so you can focus on what you do best.
Dave Dickinson, B.Comm, CFP, CLU, CHFC
Experienced Benefits Specialist ready to optimize your group benefits and pension plans.