Tackling common myths in drug plan management

What are some of the common myths and misconceptions in drug plan management? Panellists explored the issues during the recent Face to Face in Drug Plan Management conference held in Vancouver.

The discussion included live polling of the audience to give attendees an opportunity to weigh as panellists added their perspectives on the issues.

On the topic of whether biosimilars will represent savings in the future, 66 per cent of the audience believe they will. However, panel members noted that with few biosimilars on the market so far, the impact on savings and patient outcomes isn’t yet clear.

“When it comes to biologics versus biosimilars, our stance is to start, not switch, because studies do not show switching from an innovative biologic to a biosimilar is appropriate for inflammatory bowel disease,” said Gail Attara, chief executive officer of the Gastrointestinal Society. “Health Canada states that biosimilars are not equivalent. It can be a delicate dance to find a drug that is effective in the first place, so I hope plan sponsors don’t just think they’ll save tons of money by switching to biosimilars.”

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Almost three-quarters (72 per cent) of audience members agreed that new drugs aren’t necessarily better than older products. “It’s important not to lose sight of the role older drugs play as first line in a lot of clinical guidelines,” said Joyce Wong, manager of pharmacy services at Pacific Blue Cross. “You can’t say that newer drugs are absolutely more effective and should be used first line.”

While 73 per cent of audience members agreed that specialty drugs are driving up drug plan costs, Kevin West, vice-president at Innomar Strategies Inc. and HealthForward Inc., pointed to other contributing factors such as aging demographics and higher utilization. On the other hand, he said a lot of the specialty drugs in the pipeline are outstanding. “Yes, they are expensive, but the new drug for hepatitis C is a cure and there will be other cures coming in the oncology area. It comes down to the philosophy of group insurance plans.”

In terms of solutions to manage costs, it’s critical to balance that concern with plan member outcomes, said Adam Hanson, director of group strategic relations at Great-West Life Assurance Co. “Based on what’s in the pipeline, it’s just a practical reality that plans can’t afford everything. Providing everything to everyone is not going to be a long-term solution, so we have to look at sustainability as well.”

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About half (55 per cent) of the audience agreed that drug plan cost management solutions result in restricting access. Joe Farago, executive director of health-care innovation at Innovative Medicines Canada, noted that, although traditional approaches can restrict or delay access, there are ways to save money without that result. They include negotiating lower markups and fees, as well as strategies like mandatory 100-day refills for chronic medications.

“We are starting to see these taking place more often,” said Farago. “In order to pay for the innovation that is coming, you need to create some cap space. Taking a holistic view of your health plan costs is a key part of the solution.”