Amid the increasing introduction of specialized medicines in Canada, key stakeholders in the private payer health-care sector are enhancing their collaborations to maintain the value of private drug coverage, said Joe Farago, executive director of private payers and investment at Innovative Medicines Canada, during a webinar by the Group Insurance Pharmaceutical Committee this week.
“[The introduction of these medicines] will require greater innovation when it comes to reimbursement solutions and risk models and, therefore, a great need for collaboration across industries to ensure Canadians continue to have access to these innovations. Our industry is committed to new collaborations to improve the time it takes for plan members to access these new medicines.”
These collaborations include a bilateral steering group led by the Canadian Life and Health Insurance Association and IMC, which allows the organizations to work on aligned opportunities to support private drug coverage and provide plan members with access to new medicines.
IMC is also working with stakeholders in both the public and private health-care sectors to identify the best reimbursement models for plan members, said Farago. “The question we’re looking to answer is: what innovative approaches can be leveraged in the Canadian model? Canada is quite unique — it’s a mixed system with various outcome-based agreement models and other risk-sharing models.”
Also speaking during the webinar, Sheila Burns, director of health and disability policy at the CLHIA, said the association is providing the Canadian government with member data as work continues on the incoming national dental-care program, set to launch Dec. 1. The program will provide dental care for uninsured households earning less than $90,000 annually and, in its first phase, will provide coverage of up to $650 per year for children aged 12 and younger.
“It’s important this program focuses on people without coverage and that’s important to ensure the public program doesn’t cannibalize the private plans,” she said. “Protection of private plans is important both to employers and Canadians who are insured [by these plans].”
The CLHIA is also working with the Mental Health Commission of Canada to identify the scope of mental-health coverage in private plans and to advise the government on mental-health care gaps in the public sector. According to the CHLIA’s annual fact book, Canadian life and health insurers processed nearly $600 million in claims related to mental health in 2021, up 45 per cent since 2020 and 75 per cent since 2019.
“This is about more than providing a benefit or funding — one of the big issues is access to care,” said Burns. “There’s long waits and [plan members] may not be getting it early enough. A lot of disability claims are from mental-health issues, so people aren’t necessarily getting the treatment to help them stay at work.”