Sanofi survey finds plan sponsors, members misunderstand private drug plans

Plan sponsors and plan members are unaware of the key differences between private and public drug plans, according to the 2019 Sanofi Canada health-care survey.

Both employer and employee respondents said they believe private and public prescription drug plans cover close to the same amount of medications. Plan members estimated about 6,600 drugs are covered under private plans and about 6,500 are covered under public plans, compared to plan sponsors’ estimate of 7,500 and 7,200, respectively.

However, data from the Canadian Life and Health Insurance Association indicated private drug plans cover between 10,000 and 12,000 drugs, while public plans cover between 2,000 and 8,000 — for an average of 5,000.

Read: Sanofi survey finds 85% of plan members used drug plans last year

“The primary role of group insurance is to ensure plan members’ peace of mind regarding their health and wellness,” said Louis Kerba, vice-president of product development, marketing and information centre, group insurance at Desjardins Insurance and a Sanofi Canada advisory board member. “Private insurers are ideally positioned to proactively design the right combination of drug coverage and health-care benefits that continuously meets the specific and evolving needs of the working-age population.”

According to the survey, 82 per cent of plan members said they submitted at least one personal claim for a prescription drug in 2018, while 62 per cent submitted at least one for dependants covered under their plan. 

Read: Gaps persist in plan sponsor, member views on benefits: Sanofi

Personal claims were more frequent for plan members in poor health (13.9 per cent), as well as for individuals who took three or more medications regularly (14.8 per cent). When asked to estimate the amount their workplace drug plan spent on prescriptions in the past year, employees estimated $2,393 for themselves (about $299 per claim) and $2,445 for dependants ($311 per claim). The personal estimate increased to $4,771 among those taking three or more medications.Four per cent of employee respondents estimated their plan spends more than $10,000 on prescription drugs. With those claimants removed, the annual estimates were $1,182 for personal prescriptions ($148 per claim) and $732 for others ($103 per claim).

Nearly half (48 per cent) of plan sponsors said they’re concerned that improper medication use has a negative impact on their drug plan’s cost. Concern levels are the highest among employers with more than 250 employees (65 per cent) and those based in Quebec (65 per cent). In addition, 60 per cent of plan sponsors that receive analyses of their top disease state said they’re more likely to be concerned.

Read: Private drug plan claims, cost per claimant on the rise, finds new research 

“The optimal use of drugs to treat chronic conditions needs to come before conversations about coverage for higher-cost drugs,” said Danielle Vidal, director of business development at SSQ Insurance and an advisory board member. “Awareness of the impact of non-adherence appears to be growing, but as an industry, we can raise more of an alarm so that this becomes a priority for action.”

The survey also found 63 per cent of plan sponsors said they believe it would be inconvenient for plan members to fill prescriptions at particular pharmacies requested by health benefits plans — otherwise, employees might have to pay more out of pocket. On the same question, 43 per cent of plan members said it would be very inconvenient and 21 per cent indicated it wouldn’t be inconvenient at all.

One-fifth (22 per cent) of plan sponsors said they have a preferred pharmacy network in place. This number increased to 37 per cent in Atlantic Canada and 31 per cent among employers with more than 250 employees.

Read: Expert panel calling for single-payer pharmacare plan