Every stakeholder involved in health benefits management is being impacted by change; however, with change, there are also opportunities for dialogue and collaboration.

Given this reality, the theme for this year’s Group Insurance Pharmaceutical Committee (GIPC) event was emerging trends in health benefits management. The 10th annual event, held on April 15 in Toronto, brought together a cross-section of attendees to learn about the latest developments in industry drug pooling, pharmacy practice, employer-sponsored initiatives and patient assistance programs.

Environmental scans from Stephen Frank of the Canadian Life and Health Insurance Association Inc. (CLHIA) and Shannon MacDonald from Canada’s Research-Based Pharmaceutical Companies (Rx&D) provided an overview of the key developments that have impacted the group insurance and pharmaceutical industries over the last 12 months.

In addition to the launch of the CLHIA drug pooling agreement and concern about brand name drug coupon cards, the group insurance industry was impacted by government via pan-Canadian provincial bulk purchasing, provincial generic drug pricing reform and new provincial public drug plan models.

The pharmaceutical industry’s long-term objective to continue to make innovative medications available to Canadians is threatened by concerns about product safety and supply, rapidly changing access environment, competing for investment in a global economy and collaborating for long-term sustainability.

Many plan sponsors and their advisors have begun to receive their first renewals since the CLHIA drug pooling agreement launched Jan. 1, 2013. Robyn Israel, group product marketing manager with Empire Life, explained how this renewal cycle will be the opportunity to see how the new pooling mechanism will protect fully insured private drug plans from the full financial impact of high-cost drugs.

Pharmacy practice has changed across the country, driven by a new financial model resulting from government drug reform and increased scope of practice for pharmacists. William Chung, senior vice-president, pharmacy, with Katz Group Canada Ltd., suggested that with their increased scope, pharmacists prescribing for minor ailments or recommending lower-cost therapeutic alternatives can help private plans save money.

Patient programs not only help patients manage complex diseases but can also have a positive impact on their work, family and society. Dr. Ron Mayer, CEO of World Travel Protection and Adjuvantz, described patient program services that help patients access therapy through reimbursement support and healthcare-focused programs that deliver infusions and nursing support. Plan sponsors can benefit when patient programs ensure that patients adhere to therapy. There is also an opportunity to collaborate to create real-world insights on health and wellness based on patient data they collect on medication use and health outcomes.

A panel discussion rounding off the event identified several opportunities for stakeholders to work together purposefully to bring value to private drug plans. An overarching theme that emerged from this discussion was that while cost may be the biggest concern for private drug plans, it cannot be considered in isolation. Plans must look at the big picture and consider the value or return on investment they receive for the services and benefits they pay for.

Presentations from the event are available on the GIPC website.

Suzanne Lepage is a private health plan strategist based in Kitchener, Ont. suzanne@suzannelepage.ca.

Copyright © 2020 Transcontinental Media G.P. Originally published on benefitscanada.com

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