In the year ahead, the Canadian Life and Health Insurance Association will continue its advocacy efforts to ensure the federal government’s proposed pharmacare plan extends coverage for those who lack benefits without disrupting workplace benefits that millions of working Canadians rely on, says Stephen Frank, the association’s president and chief executive officer.
The right approach to achieving universal drug coverage for Canadians starts with a national formulary that all Canadians can access through either a public or private plan, says Frank. “We know the government has committed to make public what their plans are in pharmacare in early 2024. The key for us is to address gaps that may exist in the system, but [to] do it in a way that doesn’t displace what’s working well for Canadians today. So we want to make sure . . . people have access to at least as much or better medication than when we went into the process.”
Read: National pharmacare program will cost $40BN annually with shift of $14BN in private insurance
Financial support to provinces and territories is also critical to ensure all jurisdictions can deliver medications on the national formulary through their public plans and extend coverage to all Canadians, he adds, noting it’s important any new federal plan involve the public and private sector working together to ensure Canadians can benefit from lower prices on medications.
The CLHIA is also advocating for a national approach to drug coverage for rare diseases. “The federal government launched and committed to a rare disease strategy and through 2024, we expect to get some clarity on what they’re going to do. We know there are discussions happening between the federal government and the provinces and an implementation group has been put in place to figure out how this will happen.”
It’s important to understand how employers and insurers can participate in that strategy, notes Frank, adding the CLHIA can help develop strategies around access, data and assessing whether certain drugs are working.
Read: Feds name advisory group for national strategy for drugs for rare diseases
Claims fraud is another issue the CLHIA is continuing to focus on. “We’ve been working with insurers and collaborating more to identify suspicious activity by pooling data, pulling claims and looking for unusual patterns,” says Frank. “We’re also starting to jointly investigate large suspicions of fraud. So, as an industry, we’re really working together to try and squeeze fraud out of the system through education, . . . identification . . . [and] investigation.”
More broadly, he acknowledges the Canadian health-care system isn’t as robust as everyone wants it to be. “We all recognize change is needed. CLHIA sees a real role for insurers to play in helping to reform the system, so we’re looking to do a lot more with the provinces and talk about how we can be helpful for a longer-term reform of the health-care system.”
This could involve things like virtual care, mental-health supports, paramedical coverage, expanding the list of prescribers and how they integrate in the system.
Read: CLHIA working with insurers on suspected benefits fraud investigations