At 21, Jeff Aarssen was diagnosed with rheumatoid arthritis (RA).
After various treatments—including NSAIDs (non-steroidal anti-inflammatory drugs) and DEMARDs (disease-modifying anti-rheumatic drugs)—he began taking the biologic Enbrel in 2001. Aarssen is the vice-president of the group retirement services division with Great-West Life (GWL).
“It really was a miracle drug in my situation,” the soon-to-be 56-year-old said at Benefits Canada’s Benefits & Pension Summit in Toronto. “It really let me return to a quality of life that I didn’t have when I was 30, 35.”
But while Aarssen believes health is our greatest source of wealth, he admits it can also be a very big cost.
“It’s a cost to somebody,” he said, “and that burden of cost is a challenge for all of us, whether employers, providers or patients.” (GWL has paid for Aarssen’s drug coverage—$23,000 annually.)
But while Enbrel has given Aarssen the quality of life and level of productivity that he can give back to GWL, any company has to dig deep into its drug plan to ensure that this kind of coverage is still possible.
Mike Sullivan, president and founder of Cubic Health, reminded the largely plan sponsor audience that, although they have seen flat growth in their drug plans of late, that doesn’t mean they should forget about cost containment.
“You can’t have it all,” said Sullivan. “You can’t afford innovations in drug plans and best-in-class absence and disability management, while continuing to flush 10% or more of a given plan’s spending down the toilet each year.”
Sullivan said that if companies aren’t actively managing their drug plans, that is going to be the single biggest collective problem. According to Cubic Health’s database, in 2013, there were more specialty drugs released in the market in Canada than there were of all products in 2012.
“There’s a burden to manage this more carefully,” said Sullivan. “People in Jeff’s position are going to be in trouble.”
Sullivan explained that with drug plans, the past does not dictate the future, adding that plans need to look deeper than the top line of data because those trends can be misleading.
For example, say a company with 1,000 employees doesn’t have a single claim for specialty drugs. Instead, it has a claim for a chronic specialty drug in the spousal population. “How is that possible? It’s good fortune, but it’s not going to stay that way. What happens when this normalizes itself,” Sullivan said. “And it will.”
With the financial pressures of specialty drugs, and an increase in utilization, he said, it’s about proper plan management—not downloading cost to people.
All the articles from the event can be found on our special section: 2014 Benefits & Pension Summit Coverage.