Encouraging employees to live a healthier lifestyle eventually gives way to the notion that for some, the need for prescription drugs may be largely unavoidable. Plan sponsors must involve all members in an open dialogue which promotes the fact that plan cost containment starts with them. Given that the workforce is aging and utilization rates are rising, plan sustainability depends on the realization that much of the power depends on the purchasing choices of each employee and their extended family members. So finding ways to influence their decisions and make this extended network of people better consumers of healthcare is of paramount importance.

Promoting the widespread use of central dispensing pharmacies (CDPs) by plan members will help plan sponsors control costs and ensure the highest possible levels of service. The obvious benefits provided by CDPs come from the lower costs offered in dispensing fees, the greater use of generic drugs and longer days of supply that will help avoid unnecessary prescription fees. That belies the fact that CDPs offer services that bring an extra added element of personalized care and expertise in managing the drug supply chain that drive costs down while in many ways enhancing the members’ experience.

The use of CDPs must be mandated by driving patients to use the mail-order service to obtain their maintenance or chronic-care drugs. Many advisors and plan sponsors will no doubt recall how CDPs enjoyed only limited success in the past. Today’s claims adjudicators are now dedicated to the prospects of cost containment made possible by making the use of a CDP mandatory through plan design architecture that refuses reimbursement for stable maintenance drugs through any other channel.
Plan members are welcome to shop for their acute care (painkillers, antibiotics, etc.) at retail pharmacy counters where they can enjoy the full support of their plans. CDPs are often associated with name-brand retail pharmacy chains and develop full strategies where members are offered comprehensive discounted offerings, including private-label, over-the-counter, and personal care products from CDP retail partners.

Many CDPs also employ large customer call centres that provide counseling and answer patient drug-related questions once they send in their first order. This promotes a more private environment for members to discuss drug therapies with on-staff pharmacists where conversations at the retail counter may prove too exposed for some. A member can book a private consultation during business hours or at the end of the day from the privacy of their own home. Continued member benefits include prompts such as phone calls, emails or text messages to make sure maintenance drugs are ordered on time and are being taken according to their doctor’s orders. This one small metric can be responsible for saving plan costs several untold dollars as loss due to non-compliance and waste runs high in North America.

The CDP order process has been made as simple as possible to make the transition for members more palatable. A member visits the doctor and informs the doctor that he/she is making use of a CDP, providing all the necessary contact information. The doctor consults with the patient and prescribes the necessary products through a written prescription. The doctor faxes a copy of the script to the CDP where it is handled by CDP staff.

Orders can be processed and delivered using Canada Post or private courier services to a member’s home or office in discreetly packaged boxes and courier envelopes. Where needed, drugs are appropriately packaged in cold-pack storage to make sure the items arrive in top-quality condition. Drugs are delivered Monday to Friday during business hours. CDPs need to ensure there is an adult present to sign for the packages unless they sign and return a release form.

Members can transfer all or part of their drug profiles to a CDP and would do well to consider this method of order fill for all their maintenance therapy drugs. A reminder call can be made to the member to make sure they always have enough of the required blood-pressure or cholesterol-lowering product on hand, which obviates the member’s need to remember to stop on the way home to pick up their scripts. Member convenience and service are primary selling features stressed by many CDPs.

CDP programs may face opposition by plan members resisting change. When faced with the prospects of favourable plan designs paying 100% of drug costs, using the system versus low or no payment for claims made outside the new system, members will choose to comply. Over time, the new CDP system will be accepted as being completely normal, natural and even beneficial for plan members and sponsors alike.

CDPs offer great, simple cost containment and plan design compliance. Equally important though is the access to high levels of private customer service, the most efficient supply chain management possible, the promotion of the highest drug handling quality and control conditions, and order handling excellence.

Bob Carter is regional vice-president, sales — specialty programs at Empire Life. These are the views of the author and not necessarily those of Benefits Canada or Empire Life.
Copyright © 2021 Transcontinental Media G.P. Originally published on benefitscanada.com

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