How does a plan sponsor solve a problem like a massive drug claim? One solution embraced by the Canadian market is drug pooling, which goes back to the heart of pure insurance. Pooling risk to mitigate certain health-care costs is a long-standing practice in Canadian employee benefits. A benefits plan pays a pre-determined pool charge […]
In employee benefits plans, maximums and caps on prescription drug dispensing fees are common cost management features. These features are designed to nudge plan members to purchase prescription drugs at pharmacies with lower dispensing fees, lowering their out-of-pocket costs, as well as potentially reducing plan costs for employers. For example, where a drug plan has a $5 dispensing […]
On Dec. 3, the 2019 Face to Face Drug Plan Management Forum featured sessions on rare disease, the pharmaceutical industry’s point of view, legal obligations in drug plan management and a deeper dive into drug programs. Capping coverage for plan members with rare diseases poses an ethical dilemma While high-cost specialty medications represent about 30 […]
While high-cost specialty medications represent about 30 per cent of drug costs, the total budget impact of rare disease drugs is less than two per cent, said Brad McCaw, associate director of market access at Alexion Pharmaceuticals Canada. Within the high-cost specialty market’s top 20 drugs, only one is designated for rare disease, he said […]
Pharmaceutical companies and private payers can interact in different ways to ensure the right drugs are getting to the right patients, according to Kathy Sotirakos, senior manager of market access and private insurance at Amgen. Real world evidence will help inform better decision-making from a predictability and outcomes perspective, she said during a panel at […]
As the landscape of Canadian drug plan management continues to evolve, several programs are being implemented by insurers and pharmacy benefits managers to help plan sponsors manage costs. Speaking on a panel at Benefits Canada’s 2019 Face to Face Drug Plan Management Forum on Dec. 3 in Toronto, Ned Pojskic, leader of pharmacy and health provider […]
Quebec employers can expect to face significant increases to their drug pooling premiums in 2020. The Quebec Drug Insurance Pooling Corp., which sets the annual pooling parameters for private drug plans in the province, has increased the cost that plan sponsors with Quebec employees must pay per plan member. Plan sponsors pay different rates for members with and […]
Mental health is the third largest health spend in terms of benefits plan management, according to Derek Weir, manager of health benefit solutions at Medavie Blue Cross. “Fifty-three per cent of Canadians consider anxiety and depression ‘epidemic’ in Canada and 85 per cent say mental-health services are among the most underfunded in health care,” he said […]
Looking ahead to 2020, the big story for health benefits is often avoided because it isn’t easy to address. It’s the elephant in the room. Over the past year, there’s been no shortage of momentum in new and emerging product offerings in the health benefits space — everything from digital cognitive behavioural therapy to virtual […]
iA Financial Group is launching a pilot project to help benefits plan members with medication adherence. The Quebec City-based insurer will offer access to mobile app MedHelper to a few thousand plan members who are taking three or more medications on a daily basis. The plan members can import the list of drugs they take into the […]