How physicians and plan sponsors can work together to combat the rising costs of drug claims.

A new pilot project in Prince Edward Island aims to help control increasing drug costs by bringing together two parts of the complex healthcare equation—plan sponsors and physicians.

“Every time you pick up a newspaper, there’s a story about sustainability of drug prices and drug plans, and the growing spending in drug plans,” says Paul Graham, managing director, with Prescribed Solutions Consulting Inc., in Truro, N.S. “And we often wondered why it is, here in Canada, [that] nobody goes to see the physician directly with this type of message.”

Graham and his business partner, Ed Fedora, president of Prescribed Solutions, created their company in 2006 to start a dialogue between the physicians who prescribe the drugs and the plan sponsors who pay for them. In April, the firm launched a 12-month pilot project in P.E.I. with the province’s physicians and a number of large plan sponsors, including Bell Aliant, JD Irving Limited, Sobeys and the provincial seniors’ drug plan. Dr. Neil MacKinnon of Dalhousie University’s School of Pharmacy is responsible for the project’s measurement framework. Interim results are expected in November, with the final results ready in March 2009.

Big Plans

Fedora and Graham are visiting the province’s 150 or so physicians with a message about cost-effectiveness and drug plan sustainability. “We hope to see each physician [in the province] a number of times with the same message,” says Graham. A second pilot is also in the works in part of Nova Scotia. “We wanted to call on physicians on behalf of the drug plan sponsors to give [them] the message that we’re all in this together and, in order for these plans to stay sustainable, we need to work together; we need you to think more cost-effectively,” says Graham.

What’s unique about the pilot is that it offers P.E.I. physicians a 30-day trial sample of a variety of generic drugs in four therapeutic classes: cholesterol, high blood pressure, stomach or gastrointestinal disorders, and depression or mood disorders. These four chronic disease areas comprise about 50% of most drug plan spending, he adds. “In each of those classes of drugs, there are lots of choices that have gone off patent that are less expensive. We just remind the physician that this is a great drug, and it’s 50% cheaper than it was 18 months ago, so let’s use it.”

Fedora emphasizes that the pilot project is not an attempt to influence the prescribing decisions of physicians. “The best one to decide [which drug is appropriate] is the physician,” he says. “But at the same time, we need to encourage [physicians] to use this [cheaper] drug first if it’s appropriate.”

How it Works

Plan members who visit their doctors and are prescribed drugs in one of the four therapeutic classes are given a sample card to take to the pharmacy. The 30-day generic sample is then filled and recorded by the pharmacist. The sample cost is borne by the project and does not affect the plan’s claims experience.

Brand name pharmaceutical companies have been leaving drug samples with physicians for decades. But because generic drug companies focus their marketing efforts at the pharmacy level, doctors may not be aware of the cheaper alternatives that exist. “The basic premise [is] that we can effect more utilization of more cost-effective products on a benefits plan by virtue of having this messaging happening at the physician’s office,” says Leanne MacFarlane, director of business development, with Managed Health Care Services Inc., a division of Sobeys pharmacy group, in Dartmouth, N.S.

Graham and Fedora have provided participating plan sponsors with templates that they can use to communicate the same messages of cost-effective prescribing to plan members. MacFarlane says Sobeys has not yet communicated with plan members about its participation in the pilot. But Hugh Paton, senior benefits consultant, with Bell Aliant Regional Communications, in Charlottetown, says, “We’ll be giving employees the same branding, the same type of information we’re giving to the doctors. So they can take it to their doctors, and the doctors will recognize the brand and the information and link it up with the information they’ve already gotten from the consultants.”

Getting buy-in from physicians was a concern at first, but Graham and Fedora say P.E.I.’s doctors have been very supportive of the project. “The most frequent question [from them] is, ‘Why hasn’t someone done this before?’” says Graham. “Physicians are helpers. They want to be perceived as part of the solution and not part of the problem. But no one is going directly to them to say, ‘Let’s partner together.’”

Reactions from plan sponsors have also been positive. “Nobody had ever gone in and said [to sponsors], ‘You can converse with physicians and work with physicians to come up with a solution,’” says Fedora. “These large companies want to provide the best for their employees. They don’t want to say, ‘No, you can’t have this drug.’ They want to be able to give employees the best quality care and appropriate medication.”

Paton says he knew right away that he wanted to be involved. “It was the first time I’ve ever heard that a plan sponsor would be able to speak to, and influence, a group of doctors about their prescribing habits and patterns,” he notes. “I thought the most interesting thing by far is to partner with the other people in the equation, and the biggest person in the equation is the doctor who says, ‘Do you have a drug plan?’”

Desired Results

As for outcomes, Paton says he’d “like to see employees increase their awareness of drugs and drug costs, and the costs of the medications they’re using. Any increase in employee education about drugs usually leads to increased compliance and better health.”

MacFarlane cautions that “it’s a pilot project to test modalities, [but] the ideal outcome would be that we’ve been successful in increasing the cost-effective prescribing and continuation of medication management so that people are on the right drug for them and the most cost-effective choice.”

Paton is excited about the partnership opportunities among stakeholders. “We’d like to see communication and partnering between plan sponsors, pharmaceutical manufacturers, pharmaceutical retailers, doctors, employees and insurance companies—six big players in a system that have never talked to each other before,” he says. “And the time has come for them to start talking and collaborating together for success.”

Andrea Davis is a freelance writer in Guelph, Ont.

For a PDF version of this article, which includes the entire 2008 Drug Plan Report, click here.

© Copyright 2008 Rogers Publishing Ltd. This article first appeared in the June 2008 edition of BENEFITS CANADA magazine.