Originally from our sister publication, smallbizadvisor.ca.
The changes and uncertainty in today’s drug benefits landscape are a challenge to everyone. With our aging population, escalating usage rates and blockbuster-priced new drugs around the corner, many business owners are rightly concerned about the sustainability of this essential benefit.
For you, that means helping your clients make choices on how to allocate their funds to invest in their employees’ health and contribute to future business growth.
As you know, benefits can play a key role for smaller businesses trying to attract and retain top talent. As an advisor, you can help guide clients by presenting different options to find a drug management plan that fits their budget, need and plan philosophy (i.e., comprehensive versus all-inclusive) that ensure their benefits act as an advantage.
By connecting the dots between their unique goals and employee mix and an insurer that offers real choices, you can turn their plan into a unique differentiator for productivity and retention.
Emphasize a holistic approach
A truly successful benefits plan engages all stakeholders, from plan sponsors and members to government. Recognizing that everyone has a role to play means stepping back and assessing the unique and complementary roles and responsibilities each of us plays within the healthcare system.
Advisors can help clients leverage these insights, which can lead to greater efficiencies through the elimination of duplication of coverage—ensuring the plan design that your client selects is supplemental to government programming that is available.
This engagement also includes emphasis on personal responsibility—for example, by implementing a plan design that has a percentage co-pay. This means, the member pays a greater share of the total claim cost, rather than just dispensing fees or a flat dollar amount. Percentage co-pay designs are easy to understand and create incentives for the member to be engaged in the cost of the purchase. Other key elements include lowest-cost substitution. Ensure your client’s plans are maximizing this because, when several brand name drugs lose their patents, generic substitution can offer great plan savings.
The result is a plan that ensures the right drug at the right time, while being sustainable and comprehensive. Remember: comprehensive does not equal all-inclusive. Many new drugs that enter the market are “me-toos” that add unnecessary cost.
Theresa Rose is the director, group product management, with Medavie Blue Cross.