Sharing the benefits burden

Employers are divided when it comes to drugs.

On the one hand, 90% of participants in Benefits Canada’s 2015 online survey strongly or somewhat agree that it would be worth it to pay for a high-cost drug if it meant their employee continued to be healthy and productive. On the other hand, they want financial help in providing all of that largesse. A whopping 90% of plan sponsors believe that plan members need to pick up more of the tab on benefits costs, according to Benefits Canada’s research.

And that’s a challenge. “With many plans still offering 100% co-pay, there’s very little financial incentive for employees to take accountability for their spending,” said Lisa Callaghan, assistant vice-president, product, Group Benefits for Manulife Financial, during Benefits Canada’s Face-to-Face Drug Plan Management Conference in Toronto on Dec. 2.

According to Ned Pojskic, pharmacy strategy leader at Greenshield Canada, “Research has unequivocally shown that there’s a direct inverse relationship between cost sharing and adherence. As cost sharing goes up, adherence goes down. So those programs have to be carefully designed.”

Glenn Monteith, vice-president, innovation and health sustainability at Rx&D, agreed. “Depending on the thresholds, [cost sharing] can be a barrier to access.”

He said that selling employers on the benefits of picking up the costs themselves is a tricky proposition. To begin with, there’s an education gap. “It’s a cost conversation, not an investment conversation,” he said.

Pojskic felt that although there’s still “a positive view” of the return on investment, the entry of new medications is causing a shift in health-care costs that’s presenting challenges for employers that are torn between paying those costs or facing a less functional workplace.

Louise Binder, a health policy consultant at the Canadian Cancer Survivor Network, felt that carefully reviewing a plan can help sponsors to understand the value of covering high-cost drugs. So can an intensive education session with senior managers and human resource staffers available to inform them about the issues facing their plan.

“Where are the best points of entry to ensure best access but also best use of limited resources?” she said. “You may actually save money when only the right people get these drugs.”

Kevin West, vice-president of operations at Innomar Strategies, believed case management improvements could assist sponsors in seeing the payoff. “When we’re paying for drugs, particularly in the specialty areas, we’re investing thousands and thousands of dollars and we’re hoping that the health-care system is going to manage the patient for us. And I think that’s where case management kicks in.” He said that patients need to be tracked to ensure the drug prescribed is having the right outcome “for that patient.”

“If I’m going to invest the money, I want to make sure that that return is the best return,” said West.

What does the future hold? Panellists were wary. Many like Pojskic felt that “we are going down an unsustainable path.” Others, like Binder, worry that sponsors will follow the example of the public sector and “silo” everything, ultimately reducing care for employees.

“Nobody is coming to the table saying, ‘We have deep pockets and we can take on even more of the costs and spend more,’” said Callaghan. “We are at an inflection point. If stakeholders simply continue to talk about solutions without action, it is unlikely that employers can afford to simply sit and wait.

“They will start making decisions to manage costs that may significantly change how employers are participating in the health-care ecosystem.”