Should benefits cover pharmacy services?

Pharmacist Mike Cavanagh presented on behalf of the Pharmacy Health Insurance Steering Coalition (PHISC), a joint initiative by the Canadian Life and Health Insurance Association, the Neighbourhood Pharmacies Association of Canada and the Canadian Pharmacists Association. PHISC is putting the finishing touches on a package that explains the pharmacy services that could be covered by healthcare spending accounts or, possibly, as core benefits. The package includes a recommended reasonable and customary fees list and an “eligibility grid” that maps out pharmacy services sponsored by provincial drug plans.

“People on the private side ask, ‘Why should I pay when it helps the public space?’ We say, ‘Why wait to save money yourselves,’ ” said Cavanagh, who added that “privately covered pharmacy services can be more focused and measurable.”

The timing is also right due to pharmacists’ expanded scope of practice, which includes prescribing authority. “There has been such an evolution in pharmacy in the last 10 years,” says Cavanagh.

Tim Clarke, chief innovation officer, Canadian health and benefits, at Aon Hewitt, presented an advisor’s perspective. “From a fundamental health-system perspective, some of this just makes good sense. The challenge then becomes, who should pay for that good sense?” The public healthcare system, the employer, the individual or some combination of all three?” Employers need more information before they can be definitive about their role in coverage, he added.

All the articles from the event can be found in our special section: 2015 Pharmacy Solutions in Drug Plan Management Conference Coverage.

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