Pharmacies can help plan sponsors free up cash in their drug plans as the effectiveness of traditional methods of cost management fade.
That was the message Mark Rolnick, vice-president of payor partnerships and plan sponsor innovation at Shoppers Drug Mart, delivered to the audience at Benefits Canada’s Chronic Disease at Work conference last month.
Rolnick noted generic substitution has long been a primary strategy for cost containment for private plans.
“Many employers have been able to get savings on their plans through products coming off patent,” he said.
That era is “slowly coming to an end,” Rolnick added, noting that “a lot of the patent waves have kind of come and gone.”
Read: How can pharmacy help with drug plan sustainability?
According to Rolnick, whatever remaining savings employers can wring out of old techniques such as generic substitution and prior authorization will be less than predicted increases in drug spending driven by the proliferation of expensive specialty drugs aimed at patients with chronic diseases.
Shoppers Drug Mart forecasts spending on specialty drugs by private plans will hit $12 billion by 2020, a sixfold jump compared with 2010 when the total was $2 billion.
“Affording that innovation is going to be a challenge,” said Rolnick. “I would suggest there’s a volatile road ahead.”
Nevertheless, Rolnick suggested there are “opportunities for the health insurance industry and pharmacies to work together — along with employers, of course — to find ways to create additional savings.”
For example, he said that if more private sponsors actively managed their drug plans, they could adopt tiered formularies that prioritize certain drugs. Pharmacists already deal with formularies when it comes to government-sponsored drug plans, Rolnick noted.
“They know the alternative, if a doctor writes a prescription for a product that’s not in the Ontario drug benefit program. They call the doctor back, get it switched up and it happens very quickly.”
It’s harder for pharmacists to get a handle on all of the coverage differences between private drug plans, but Rolnick said they could make a start if sponsors provided them with that information.
“I would suggest there’s enough money to compensate pharmacies for their time to help achieve the savings. It’s a one-time, small investment for consistent savings over time,” he said.
Rolnick said pharmacies could also help ensure doctors are prescribing certain therapies in the right order and cut down on drug wastage by managing prescription intervals.
He said that working with pharmacies makes sense since that’s where plan members often find out about coverage issues.
“They are the front line,” said Rolnick. “Despite the best intention of employers, from a patient and consumer standpoint, their plan is a bit complicated. They don’t necessarily understand it, and the pharmacy is a big part of the support function.”