sustainability of their drug plan. Some employers, unsurpris-ingly,
are responding by looking at solutions that pass more of
the cost burden along to their employees, and this approach can
prove problematic, given the potentially negative message it sends
and the implications it has on health and wellbeing, recruitment
Canadian employers spend more on prescription drug coverage
than on any other benefit, and that’s not changing anytime soon,
according to a 2015 study. The Canadian Institute for Health
Information (CIHI) says that drug spending by the private sec-tor
has doubled from $8.8 billion in 2003 to $17.6 billion in 2015.
“Cost containment is always top of mind in this situation, and
the solution is not to introduce annual minimums on prescription
coverage or to ask employees to obtain individual coverage,” said
Edwin Ho, Express Scripts Canada’s senior manager of pharma-cy
operations for Western Canada. “This can limit employee access
to some necessary, life-changing, medical treatments, which could
translate into an absent workforce that is not willing to give an em-ployer
their time and full commitment to the job.”
The Express Scripts Canada 2016 Drug Trend Report revealed
that 14 per cent of plan members account for 72 per cent of to-tal
plan spending. Innovative solutions are required to help plan
members make better decisions to manage their overall cost and
to manage their overall health.
The Sanofi Canada Healthcare 2016 study also found that 59
per cent of employees require medication for one or more chronic
conditions, such as high blood pressure, mental illness and arthri-tis.
How employers use, fund and tailor prescription health benefit
plans to support aging employees who are sick or have fluctuat-ing
or chronic health problems is more important now than ever.
One out of every five dollars spent on prescription drugs in
2016 paid for medication for diabetes or an inflammatory con-dition.
Spending on high-cost drugs to treat complex, chronic
conditions such as hepatitis C and cancer has grown from 13 per
cent of total drug spending in 2007 to 30 per cent in 2016. It’s no
wonder employers are seeing huge spiralling costs.
“Plans are not comprehensively managed and employees are
consuming a large portion of their total prescription drug spending
on high-cost specialty medications,” said Herbert. “Employers are
feeling the pinch, with specialty drug spending on track to reach
40 per cent of total drug spending by 2022, threatening overall
employee plan sustainability.”
THE SOLUTION – DATA ANALYSIS AND
COMPREHENSIVELY MANAGED PLANS
Effective intervention is required. Employers are overwhelmed
by the costs and plan members don’t understand the various
factors in treatment complexity. Sponsors need to implement ef-fective
plan management solutions before cost increases become
insurmountable, and employees need expert guidance at key de-cision
Traditional approaches to plan management do not work.
Informed plan members make better choices and refrain from
using costly medications, without first asking about the more
affordable alternatives. They also take their medications as pre-scribed
by the pharmacist, which leads to better health outcomes.
Through this process, they pay less for prescription drugs by elim-inating
the need for more expensive treatments.
“In this complex environment, it comes down to comprehen-sively
managed plan controls that allow for targeted intervention,
and provide support for members at key decision points along the
treatment journey,” said Herbert. “When employers implement
these measures, they typically witness between 10 to 15 per cent
cost savings in drug expenditures.”
When plans are comprehensively managed, leveraging clinical ex-pertise
and data analytics, patient drug utilization aligns with clinical
guidelines. It empowers plan members during critical decision-mak-ing
periods, and provides comprehensive care to older members who
may have multiple chronic conditions. While also incorporating
synergistic management techniques and formulary, utilization and
clinical management tools, the outcome will be healthier employees
at a lower cost. n
Anthea Gomez is the director of human resources and corporate
services for Express Scrips Canada.
HOW EMPLOYERS USE, FUND
AND TAILOR PRESCRIPTION
HEALTH BENEFIT PLANS TO
SUPPORT AGING EMPLOYEES
WHO ARE SICK OR HAVE
FLUCTUATING OR CHRONIC
HEALTH PROBLEMS IS MORE
IMPORTANT NOW THAN EVER.
30 ❚ SEPTEMBER 2017 ❚ HR PROFESSIONAL