Canadian employers that use drug plan management strategies such as pay-direct cards, generic substitution or dispensing fee caps can realize significantly lower healthcare costs.
What could we do in an area like this if we had nearly $62 million every year to invest in plan members instead of lighting that money on fire?
When plan members don't take their medications for chronic conditions, it can also have a negative impact on employers' drug plans.
The number of high-cost prescription drug claims that Canada's private insurers covered for Canadians with fully-insured supplementary health insurance plans doubled in the Canadian Drug Insurance Pooling Corporation's first year of operation.
This spring, the Canada Health Accord, the 2003 agreement between the federal and provincial and territorial governments on healthcare delivery and funding, expired. Although the current federal government has set out a new funding formula for health transfer payments to provinces, funding will be tied to economic growth and population size without adjustments to account for healthcare inflation. And while there is a position on funding, there has been little apparent movement or discussion about the delivery of healthcare going forward, and that has many wondering what this means to Canadians.
The Empire Life Insurance Company has signed an agreement with Express Scripts Canada to provide pharmacy benefit management services to its group customers.
Manulife has entered into an exclusive partnership with healthcare provider Bayshore HealthCare to deliver a specialty drug care program, which features drug case management services and a preferred provider network.
A large plan sponsor with both active and retiree drug coverage faces a serious threat. The plan is already dealing with 32% of its more than $10 million in annual drug plan spending being diverted to a small number of expensive specialty drug claims. That figure was below 14% of plan spending less than five years ago. Nearly 80% of the specialty drug spending is being allocated to chronic therapies, therefore the plan can expect the vast majority of the claims to reoccur every year.
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The New Brunswick government has established the New Brunswick Drugs for Rare Diseases Plan, which will provide assistance to those with certain rare diseases who face high drug costs.