Drug spend in Canada may have remained flat in 2011, but private drug plans wasted approximately $5 billion last year, according to Express Scripts Canada’s latest Drug Trend Report.
The perfect storm in global economies over the past few years has dramatically transformed human capital and benefits markets, and an HR department must determine how to maintain—or even improve—its organization’s competitive advantage and sustainability in the current climate.
Back in the 1980s, when I worked in my father’s pharmacy, everything was fair game from a drug reimbursement standpoint. It’s incredible to think that, decades later, private drug plans have not become materially more sophisticated in how they manage what is and isn’t paid for.
Rising drug plan costs, tighter restrictions on government-paid medical coverage, more employees working past age 65—all of these factors will play a role in driving up benefits plan costs in the next few years.
It’s strange that, in all of this, there has been very little attention placed on the 70% to 75% of private plan spending that is still represented by spending on brand name products. It’s even more surprising that there is less focus on the pipeline of innovation that awaits the marketplace.
Infertility is on the rise in Canada, as various studies referenced in the March 2012 issue of Human Reproduction indicate. In 2009/10, 16% of heterosexual couples in which the woman is age 18 to 44 are experiencing infertility—nearly double the 1992 figure (8.5%).
What keeps plan sponsors awake at night? According to Joyal, soaring costs and retirement benefits rank high on the list.
Just two years after legislation forced generic prices down 50% to 25% of brand for Ontario Drug Benefit recipients, prices may soon be cut even further.
Pharmacy benefit management (PBM) services are one option available to enable plan sponsors to better manage the cost of their prescription drug benefits while also providing members with an enhanced prescription drug service.
Unless benefits advisors have walked a mile in these shoes, it is difficult for them to relate to these daily and often fundamental challenges. Group benefits is but one of a number of items all competing for a space at the owner’s table and on the income statement.