Solutions to ease employee backlash to plan design changes

Keeping private drug plans sustainable is key for all Canadians. While measures such as mandatory generic substitution and prior authorization are standard solutions in many employer drug plans, costs continue to rise.

As employers consider what to do next, there’s a role for pharmacy to play, according to Mark Rolnick, vice-president of payor partnerships and plan sponsor innovation at Shoppers Drug Mart.

“Pharmacy is really an untapped resource for employers and insurance companies. Not only are pharmacists widely accessible, but their scope of practice is increasing,” said Rolnick during a session at the Nov. 23 Calgary Drug Trends Summit.

“Pharmacy is the silent partner of employers.”

Read: ‘The sky is not falling’ on drug costs

Pharmacists are in a good position to provide information and education to plan members, Rolnick suggested. “When we ask sponsors about what’s preventing them from making changes to their plans, it’s all about the employee experience and their concerns about plan member complaints and backlash. This is where pharmacy can help, through educating and informing.”

It’s at the pharmacy level, when they’re filling a prescription, that plan members will find out about any changes to their plan coverage. If a plan has limited or cut back reimbursement or it doesn’t cover a drug, members need to know why and what options they have, said Rolnick, pointing out that pharmacists have the ability to support plan members by answering their questions. At the same time, pharmacists also need more information from insurance companies and pharmacy benefits managers about alternative treatments. “If we had more information, we could provide more support and improve the member experience,” said Rolnick, noting the approach would help reduce employee concerns when employers adopt a more actively managed plan.

Read: Metabolic syndrome targeted as part of efforts to reduce chronic disease drug spending

Recent market research on drug plans supports pharmacists’ role in an environment of rising costs, said Rolnick, who emphasized that plan advisors and sponsors have an opportunity to think about how to engage with pharmacies.

“Employers should be thinking about how pharmacy can help them get better investment returns from their limited benefits dollars,” said Rolnick. “What more could you do to control drug plan costs if you had pharmacists in your corner to help support plan members through your plan design changes?”