As plan members deal with the increased complexity of benefits plans, what’s the role of pharmacies in helping them understand and navigate the various rules around drug claims?

“Pharmacy is obviously a big part of helping these solutions come alive for plan members — whether it’s the pharmacy supporting the plan member through the drug plan generic substitution at the pharmacy, whether it’s helping find the prior authorization form or advising that to the plan member,” Mark Rolnick, vice-president of payor partnerships and plan sponsor innovation at Shoppers Drug Mart and Loblaw Companies Ltd., said during a session at the 2017 Pharmacy Solutions in Drug Plan Management forum in Mississauga, Ont. on Oct. 18.

While the various drug plan management solutions have helped to generate savings, spending continues to grow, said Rolnick. He referred to the 41 per cent of benefits advisors recently surveyed by Shoppers Drug Mart who cited rising costs as the most significant change in the insurance industry that’s having an impact on their business today as it relates to prescription drug benefits.

“The innovation in the pharmaceutical industry is pretty impressive, and the growth in the value of new medications coming is looking pretty bullish from a pharmaceutical standpoint. Of course, that presents some challenges to employers and plan sponsors.”

Read: Conference coverage: Pharmacy Solutions in Drug Plan Management forum

On the issue of rising costs, plan sponsors surveyed say they’d consider implementing a number of solutions, including mandatory generic substitution, prior authorization for more expensive drugs, therapy class restrictions, therapeutic substitution, step therapy and a more restrictive formulary.

There is a role for pharmacies when it comes to several of those options, as they provide a “great access point” to intervene, said Rolnick.

“Not only is pharmacy accessible, but there’s a growing understanding of the role of pharmacy through the expanded scope and expanded skill sets a pharmacy can offer,” he told attendees at the conference.

For example, pharmacists are able to renew prescriptions when refills expire. In Alberta, pharmacists can do tests for strep throat.

As the Shoppers Drug Mart survey found, two-thirds of benefits advisors strongly agree that pharmacists are a resource available to plan members for patient health management.

“Pharmacy is willing to help,” said Rolnick. “Pharmacy needs the information to support plan members when plan design changes happen, and I think you’d see the pharmacy community being able to rally around these types of opportunities.”

Copyright © 2018 Transcontinental Media G.P. Originally published on benefitscanada.com

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