Joanne Jung:

Having worked with many private plans with BC employees, I totally disagree that 99% of time specialty drugs are not covered. In fact, BC PharmaCare covers most of the more commonly used specialty drugs for autoimmune conditions. I would like to know where Sharon Dent’s data came from.

Tuesday, August 13 at 12:27 pm | Reply

Chris Pryce:

I would agree that closed formularies provide meaningful cost relief because, rather than include a drug and use prior authorization to determine if there is a usage case for the drug, the closed formulary simply does not pay for it. Some might suggest that is brilliant…Can’t speak for B.C. employees but ON employees are just starting to wrap their heads around the cost advantages of using generics, so it’s a leap to think that reference pricing is remotely appealing, i.e., doctor prescribes generic, but patient did not go on Telus app at their office, so now the script is cut back because there was some drug in the reference class that was $10 less. Yes, 23.8% savings is big, but how many employees gave up using the plan in frustration after claims were cut back or rejected. The researchers should look to alternative data points to determine if some of the savings “leaked” to other silos, i.e., lost time, disability and more intensive hospital utilization from members not taking their medications.

Wednesday, August 14 at 11:06 pm | Reply