With plan sponsors concerned about the sustainability of their drug plans, a panel of experts at the 2016 Face-to-Face Drug Plan Management Forum in Vancouver discussed how employers can get their plans on track to be sustainable for the long term.
The panel included Kevin West, vice-president at Innomar Strategies; Joe Farago, executive director, health-care innovation, at Innovative Medicines Canada; Joanne Jung, director of pharmacy services at Pacific Blue Cross; and Dr. Sunil Kalia, assistant professor at the University of British Columbia. Robert Taylor, principal at TRG Group Benefits & Pensions Inc., moderated the panel.
The discussion covered exclusive Benefits Canada research on the views of more than 200 plan sponsors.
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According to the research, 83 per cent of respondents say the new drugs coming to market are too expensive for their plans to remain sustainable; 70 per cent are concerned their drug plans won’t be sustainable in the long term; and 90 per cent of respondents agree that in order to keep drug costs manageable, employees need to share the burden in some way.
Farago said co-payments are a reasonable approach and noted that if someone has to pay a portion of the bill as part of a plan, it may create greater accountability. He also said plan sponsors should consider the potential consequences if co-payments become too high. “There have been a number of studies suggesting that if the co-pay or cost-sharing levels get too high, then people don’t take their medication,” he said.
Jung agreed and said that if employers shift costs to the employee, there could be more responsibility but noted that if the amounts become challenging to pay, there could be delays in starting the prescription or abandonment of the medication. The impact could depend on the cost of the drugs or the type of disease. For example, cost shifting tends to have less impact on drugs to treat cancer in comparison to other conditions such as rheumatoid arthritis or multiple sclerosis.
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Another way to manage costs is case management, according to the panel. West pointed to the importance of case management when paying for high-cost drugs. He explained that with some conditions, such as rheumatoid arthritis, there are numerous drugs that may all work differently for different people.
“From the payers’ perspective, they are fine to pay for the drug but they want it to work,
he said. “It’s all about monitoring that patient to make sure that they’re on the right drug in that category and getting the best outcome that they possibly can.”
West said he’s surprised at how few plans are doing case management. “At this point in time, very, very few payers are actually doing this in the Canadian market. They’re depending on the traditional treatment paradigm of letting the physician monitor the patient and outcomes,” he said.
He suggested plan sponsors take a more active role. “Even in specific disease states of diabetes, or hypertension, or pain management, or mental health or specialty, if you’re being reactive and simply throwing dollars at it and not proactively managing the patient and the patient isn’t taking the drugs effectively or is not having a good outcome, you’re pretty well wasting your money,” he said.
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Jung said there are still a lot of opportunities to control costs and noted national plan data has found more than 20 per cent of drug spend is on specialty medications. Jung asked what plans are doing about the remaining 80 per cent. She mentioned generic substitution and more cost-effective pharmacies as potential courses of action.
“Maybe applying other cost-containment strategies, such as generic pricing, is a way to help pay for these new advanced therapies,” said Jung.
Read more from the Face-to-Face Drug Plan Management conference