With public payers across the country acknowledging the value of pharmacy by expanding scopes of practice and funding more services, there are opportunities for drug plan sponsors to capitalize on pharmacists’ expertise to better manage spending and improve health outcomes.
That was the message conveyed to attendees at this year’s Solutions in Drug Plan Management conference, which was held at the Sheraton Toronto Airport Hotel in September 2011.
Roughly 130 people representing various stakeholder groups—drug plan sponsors, benefits consultants, adjudicators, pharmaceutical companies, pharmacists and insurers—attended the half-day event presented by Benefits Canada and Drugstore Canada magazines. The annual event was jam-packed with presentations that ran the gamut: from how the pharmacist’s changing role can benefit plan sponsors, to how—and why—employers should incorporate pharmacy services into their drug plans.
Finding a partner
Peter Zawadzki, professional affairs executive with Pharmasave National, and Jeff May, senior vice-president, pharmacy professional affairs and payer relations, with Shoppers Drug Mart Inc., led off with a discussion about how the quickly evolving healthcare landscape sets the stage for partnerships with private payers.
Both public and private payers are benefiting from provincial initiatives to lower generic drug prices, and the loss of patent on blockbuster drugs such as Lipitor is adding even more savings. May pointed out that some public payers are reinvesting a portion of those saved dollars into enhanced pharmacy services. Although lower generic prices have contributed to reducing drug spending, he stressed that ongoing cost issues remain. “We don’t yet know the impact of biologics entering the market, and payers still have to deal with rising utilization rates,” he explained. “One employee could cost the drug plan $35,000 a year, and employers need to make tough decisions on how to reallocate costs to ensure that benefits continue for all employees.”
Zawadzki explained that with the pharmacist’s role changing from drug dispenser to medication therapy manager, new opportunities are opening up for partnerships. The development of the Canadian Pharmacy Services Framework, as part of the Blueprint for Pharmacy initiative, has created much-needed standardized definitions and terminology that will help payers to understand the different services that pharmacy can provide.
“We need to show plan sponsors how to incorporate pharmacy services such as medication reviews, therapeutic substitution and prescription adaptation into benefits plan designs with the objective of improving employee health,” Zawadzki said. “Rather than looking at fee caps, the sponsor’s focus should be on linking health and wellness to the plan’s drug spend.”
Pharmacy services and private plans
Helen Stevenson, former assistant deputy minister at the Ontario Ministry of Health and current president and CEO of Reformulary Group, participated in a panel discussion with Chris von Heymann, senior vice-president of Cubic Health Inc., and Deb Saltmarche, pharmacist consultant and healthcare strategist. The trio of pharmacy experts explored different ways to apply pharmacy services to private drug plans.
Drawing on her previous experience as executive officer for Ontario Public Drug Programs during drug policy reforms, Stevenson suggested a range of cost-saving strategies for private drug plan sponsors, including the creation of customized evidence-based formularies; looking closer at drug pricing, markup and frequency of dispensing; making the most of reduced generic prices; considering joint-purchasing initiatives among insurers; and funding pharmacy services that support formulary and chronic disease-related programs. “There’s a real gap with respect to programs for employers to implement some of the newer ways to help employees adhere to medication therapy,” she said.
Preferred provider networks (PPNs) are a common strategy for drug plan sponsors to manage drug costs. Von Heymann talked about what payers need to know about PPNs, how to encourage uptake among plan members and how to help ensure ongoing success. He added that employers can use the savings realized from various preferred provisions to directly fund enhanced pharmacy services, such as screening programs and clinics in the workplace, disease management programs and other employee wellness initiatives.
Saltmarche provided another perspective on why medication management should be part of every drug plan, stressing that safe and effective use of medications achieves better health outcomes. “It is time for a change in partnership between pharmacy and benefits plan sponsors,” she remarked. “Pharmacists have the ability to manage employee health, and sponsors should take advantage of the low-cost years to invest for the future.”
Putting ideas into practice
For anyone with doubts that such strategies can play out in the real world, Basil Rowe, vice-president, total rewards and shared services, with Shoppers Drug Mart, was on hand to talk about Shoppers’ recent experience with redesigning its drug plan and laying the foundation for employee wellness. Implemented in January 2011, the new plan included formulary changes (custom formulary, tiered co-pay, generic leadership and utilization management), a wellness solution (health risk assessments, mentored and self-help programs, mental health and stress triage, and personal wellness accounts and incentives) as well as a chronic disease management program (for diabetes, rheumatoid arthritis, multiple sclerosis and cancer).
In just a few short months, drug costs fell by nearly 15%, 20% of plan members enrolled in wellness programs, and the chronic care program had a 40% participation rate. “We are seeing changes in our members’ behaviour,” Rowe added. “They appreciate their benefits more and are taking advantage of disease management services. And there are still significant opportunities to further leverage pharmacy services for medication reviews, step-therapy and disease management.”
Gaining momentum
One of the highlights of the annual conference is the opportunity for participants to share their views with other stakeholders in roundtable discussions. This year, the roundtables focused on various issues raised during the presentations. The mix of stakeholders ensured a lively conversation with a variety of opinions and ideas on pharmacy’s potential to help payers manage drug costs and promote employee health. With lower generic prices currently moderating drug spending, provincial legislation expanding pharmacy’s scope of practice and the latest technology capable of monitoring care delivery and outcomes, many agreed that the time is right for greater collaboration between pharmacy and private payers.
Sonya Felix is a freelance writer based in St. Catharines, Ont. sfelix@cogeco.ca
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