Non-adherence to prescribed medication and lack of communication among the various healthcare stakeholders are two of the main issues that continue to plague Canada’s workplace drug plans.
That was the message at the Canadian Leadership Council on Drug Plan Partnerships, hosted by Benefits Canada in Toronto.
Communication breakdown
Currently, the stakeholders involved in workplace drug plan management—plan sponsors, plan members, physicians, pharmacists, consultants and insurance companies—have no channels of communication, said Bessie Wang, director of professional services at Telus.
Part of the reason for this problem? “Every stakeholder has their own agenda and interest,” Wang said. For instance, while the job of a plan sponsor is to contain costs, a physician doesn’t normally have to worry about that.
The lack of communication means that there are “possibly duplication efforts” in the system, Wang said.
A typical example of working in silos is when physicians prescribe a drug based merely on what they think is best for the patient, without considering what the drug costs or whether it’s covered by the patient’s health plan. Due to lack of communication, doctors have no information about what drugs are covered for patients. This means, plan members may have to pay out of pocket, which, in turn, could result in them not taking the drug and thus not addressing their health problem, Wang explained.
In the end, the plan sponsor suffers, too. “The sponsor is normally the party that foots the bill,” Wang said. “When all stakeholders are working together, they’re helping the patient return to work.”
Non-adherence
Apart from lack of communication, another problem is that many patients do not adhere to their prescriptions. This problem affects every element of the food chain.
For example, if a plan member has high blood pressure but doesn’t take his or her medication (regularly), the member starts to feel worse and less productive at work and might even get a heart attack, which causes the member to be absent from work. The pharmacy is also hurt, because the patient doesn’t go back to refill the prescription.
That is why patients need to be given proper information about the importance of adherence, according to the panel. Patients also need to be educated about the side effects of medications because, if they’re not, they might discontinue the treatment, the panellists added.
The problem of non-adherence needs to be brought to the attention of plan sponsors, too, said David Willows, vice-president of strategic market solutions with Green Shield Canada. “We’re [still] not going up to plan sponsors and talking about this,” Willows explained.
In addition, the benefits of adherence need to be quantified so that a strong business case for it can be made, said Connie Wong, director of pharmacy benefits at Manulife Financial.
“We need to translate the benefits of adherence into financial terms,” she said, explaining that there isn’t much data right now. “It’s not readily available from carriers. [And] if I can’t measure it, there’s no way to establish that it’s actually delivering value.”
But if data is available, then it can be presented to the plan sponsor, which then can pay the other stakeholders—pharmacies, carriers and consultants—to remind members to take their medication, Wong explained. Asking the patient to pay for that would be unrealistic, she added.
The panellists agreed that yet another solution could be to create a culture where non-adherence is stigmatized—just as nowadays society frowns upon habits such as drunk driving and smoking in public places.