The clear message when Loblaw and Shoppers Drug Mart prepared to redesigned their benefits plan was that they weren’t going to spend any more money.
“When you put the dollars we were spending against the impact and outcome, we weren’t getting a return on investment,” Basil Rowe, senior vice-president, for total rewards at the retailer, said during a panel at Benefits Canada’s 2016 Benefits & Pension Summit on March 31.
“We went through and did a better job of reinvesting those dollars. You can free up dollars to reinvest in those high-cost critical cases, supported by reimbursement specialists that take a look at other funding sources.”
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Among the considerations for plan sponsors is to ask whether they’re optimizing their health-care spend. “Certainly, when we looked at our plan, we made a number of changes and said we weren’t optimizing it,” said Rowe. “So I think there’s a look that can be done in plan design.”
Delegates at the session on the role of technology in drug plan management also heard that plan sponsors should be including physicians and pharmacists in the conversation.
“If you look at how physicians and pharmacists can collaborate, particularly where there are expanded services, ensuring that we are maximizing generic utilization, where possible, even thinking about facilitating substitution within a therapeutic class,” said Jeff May, executive vice-president and general manager at Remedy Holdings.
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“If the alternative is not available in your office, we can help make those decisions. Even today, there are structures in even public plans that are starting to facilitate substitution within a category to get the best cost medicine. If the physician or pharmacist can use their expertise and focus on that process, then there is a ton of money to be saved.”
A collaborative approach and focus on plan design are particularly important considering recent findings from an annual Telus Health survey that showed while only 0.55 per cent of drug claims in Canada are for specialty drugs, they make up more than 23 per cent of claims costs.
“This number is staggering and it will continue to go up,” said Karen Kesteris, director of product management at Telus Health, during the session.
“The biggest challenge in our industry right now is who is going to pay for it.”