Halifax Professional Firefighters Benefits Trust was the recipient of the Drug Plan Management Award for Benefits Canada’s 2011 Workplace Health & Benefits Awards.

Five years ago, Halifax Professional Firefighters took a big step with their benefits plan when they chose to begin actively managing the plan themselves. The change was risky, and the learning curve was huge for a bunch of firefighters thrown into the benefits world, but the results have been worth the effort, says Chris Camp, chair of the Halifax Professional Firefighters Benefits Trust.

The idea of dropping a fully insured plan seemed crazy to some members. “But as firefighters, we are stubborn and don’t give up on things—and, considering our occupation, that’s a good thing.” The group, which includes about 550 employees plus dependents, went ahead and hired a consultant, created a board of trustees and moved their drug plan to Managed Health Care Services Inc. (MHCSI), a pharmacy-owned and operated pharmacy benefits manager.

By moving their drug plan to MHCSI, Halifax Firefighters adopted a managed formulary process and a preferred provider solution for pay-direct drug benefits. With incentives built into the preferred provider program, participation now runs upwards of 90%, says Camp, explaining that members have a $10 co-pay on all prescriptions but can only use the pay-direct card at preferred providers. Otherwise, they have to wait for reimbursement. “It was a hard sell at first and there was a lot of confusion, but after a lot of communication, people understood, and it is better now,” he says. Another incentive is a financial reward the plan receives from MHCSI: every time someone uses a preferred provider to fill a prescription, money goes into a scholarship fund for the firefighters’ children and, over five years, more than $70,000 has been distributed as scholarships.

Every month, the plan’s board of trustees meets to monitor drug usage and claims, and to deal with administrative and governance issues. The group’s drug plan management strategy demonstrates consistent reductions in overall per-member drug claims utilization and costs. Improvements in generic fill rates, adherence to three-month supplies on maintenance drugs, the managed formulary process and optimization of co-ordination of benefits have contributed to the positive trend. Members receive medication reviews and disease state management services provided by the pharmacists.

Greater emphasis on wellness has helped lower costs, especially for cardiovascular and diabetes claim utilization. “We realized that an ounce of prevention goes a long way,” says Camp, noting that the firefighters now have annual health risk assessments, biometric screenings and nutrition education. “Our members and their spouses are healthier, and some of them got off cholesterol and blood pressure drugs because they are taking better care of themselves.”

Although changing mindsets isn’t easy, Camp says that after five years with no premium increases, people are now convinced and happy with the drug plan. “At times, it was a tough battle, and the board had to make unpopular decisions,” he says. “That’s why getting this award from Benefits Canada is so gratifying. This kind of recognition helps me to know we are doing a good job.”

Sonya Felix is a freelance writer based in St. Catharines, Ont. sfelix@cogeco.ca

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Copyright © 2019 Transcontinental Media G.P. This article first appeared in Benefits Canada.

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