Splitting the bill on drug plan costs

Chronic illnesses cost employers big dollars in declining productivity and soaring drug costs. One-third of Canadians are diagnosed with one of seven chronic diseases, many of which co-occur, according to Chris Bonnett, president of H3 Consulting. Bonnett opened the 2012 Solutions in Drug Plan Management conference with this and other difficult facts. Today, cancer, heart disease, stroke and diabetes account for 70% of deaths. Since older people are more likely to have chronic diseases, their impact on the workplace will grow as the workforce ages.

Read this

New drugs may offer more effective treatments for chronic diseases. Many employers, however, wonder how they can afford them. As part of the conference, an expert panel examined this pressing issue.

Sharing the burden
One key factor in managing drug costs is whether employees share responsibility for controlling drug spending. Marilee Mark, vice-president, marketing, group benefits, Manulife Financial highlighted findings from a 2012 Sanofi Canada Healthcare Survey suggesting employees may take their obligation more seriously than employers think.

Nearly two-thirds of employees surveyed said they view coverage for higher-cost drugs as a very high priority. Asked what they’d be willing to do to assist employers with drug costs, 62% said they’d “shop around” for drugs, 21% would pay for additional coverage, and 15% said they’d be willing to pay higher premiums. Most respondents (92%) also said they’d likely participate in on-site health risk screenings, and 91% were willing to participate in disease education in order to ensure coverage of higher-cost drugs.

Private health plan strategist Suzanne Lepage suggested applying a disability claims management approach to drug claims. “Disability case management provides a single point of contact to co-ordinate the claim, ensures consistency of treatment and provides referrals to appropriate healthcare professionals,” she said. “Drug claims case management is not that different.”

Lepage pointed to the case management strategy’s greater returns on drug spending and reduced absenteeism and disability rates. It does demand trade-offs in outcomes and satisfaction, however. For example, case managers can limit medication choice or alter treatment plans, making alternative therapies inaccessible.

Pharmacist and professional affairs executive for Pharmasave National Peter Zawadzki suggested plan sponsors explore partnerships with healthcare professionals. He pointed to newly expanded scopes of practice allowing pharmacists to adapt and extend prescriptions to improve adherence and decrease absenteeism. Plan sponsors in some provinces can also employ government-paid pharmacy services such as medication reviews or diabetes care to reduce health- and disability-related costs.

Cost-effective drug plan management takes ingenuity and initiative on the part of employers and employees alike. As with any big-ticket item, it hurts less when all parties pitch in to cover the tab.