With Canada’s public and private drug market an ever-evolving landscape, what value can be gained from collaboration and innovative solutions to ensure patient access to new medicines and vaccines in the future?

During Innovative Medicines Canada’s virtual policy summit in June, Declan Hamill, vice-president of policy, regulatory and legal affairs, said the organization appreciates the value of the private market, but also recognizes that some new innovations put strain on traditional insurance models. “We see an opportunity to work together to find solutions to ensure the viability of private plans.”

The importance of innovation and collaboration

Innovation can advance in large strides, such as a new breakthrough medicine that offers treatment or a cure where one didn’t previously exist, but more often, “innovation comes as a series of small steps, or incremental innovation that offers improvements on existing treatments,” said Cole Pinnow, president of Pfizer Canada. “These treatments can be more effective, better tolerated or have fewer side-effects, which can offer patients enhanced convenience or quality of life.”

Read: Is innovation causing accessibility, timing issues for private drug plans?

There are issues in common where the private payer and pharmaceutical industries can come together to shape policy. For example, both agree on the importance of a high-functioning private health benefits market in Canada.

There’s an opportunity to collaborate through open dialogue to establish issues, “where we can work together to shape policy and practices that benefit both sectors going forward,” said Pinnow. “For example, we can shape the discussion for national pharmacare and ensure a strong private health insurance sector, with a focus on a national policy that fills the gaps for those that don’t currently have access to medicines.”

Innovative agreements can improve access to novel treatments and allow plan sponsors to continue to offer high-quality benefits to plan members, said Glenn Monteith, senior associate of global public affairs at the IMC. “Payers that consider agreements that manage access responsibly, using evidence and shared-risk management tools can smooth out the budget impact for plan sponsors and be considered an industry leader.”

Assessing, managing private drug claims requires a different perspective

As newer therapies are developed to treat conditions that previously lacked effective treatment options, patients are accessing medicines that can significantly improve their health, prevent further disability and allow them to live more productive lives.

Read: The potential effects of public drug plan changes on new therapies in Canada

Unfortunately, some of these benefits aren’t captured in the cost of the drug plan. Instead, they materialize in reduced absenteeism or long-term disability. There are opportunities to work together to uncover this value and highlight it to plan sponsors.

The overall private drug claims growth rate of 5.3 per cent is reasonable; however, we need to find a better insurance model to manage the impact and risk of high-cost claims for small groups.

Chronic disease continues to be the largest contributor to overall costs and claims growth and is a key driver of utilization. An opportunity exists for employers to offer programs to improve plan member health and reduce their risk of developing chronic diseases. This could have significant impact on future drug claims costs and free up dollars to fund innovative new medications.

Joe Farago is the executive director of private payers and investment at Innovative Medicines Canada.