The Halifax Professional Firefighters Benefits Trust has been actively managing its plan since going to an administrative services-only program and moving its drug plan to a pharmacy benefits manager (PBM) five years ago. This move meant adopting a preferred provider pharmacy solution for pay-direct drug benefits, which members supported with high participation rates.
The board of trustees is highly engaged in monitoring and managing plan usage, reviewing performance and plan coverage on a regular basis, and adopting the PBM’s managed formulary process, which includes prior authorization and step-therapy protocols. Plan members also benefit from medication review and disease state management services provided by its front-line pharmacists.
The trust is also focused on promoting wellness among its members, partnering with its PBM to offer health risk assessments (HRAs) and biometric screening clinics. In addition, it undertakes healthy eating initiatives by focusing on nutritious meal preparation at the fire stations.
These collective efforts contribute to a comprehensive and cost-effective benefits plan. Over the five years, the trust has achieved a consistent reduction in its overall per member drug claims use and costs by 9% and 8%, respectively.
Contributing to this trend are improvements in the generic fill rates and adherence to three-month supplies on maintenance drugs, along with a managed formulary process and optimization of co-ordination of benefits. The trust has also kept its $10 co-pay per prescription unchanged.
Impressively, the trust has demonstrated reductions in its cardiovascular and diabetes claim use and cost trends of more than 20% and 16%, respectively, since implementing the annual HRAs, biometric screening clinic and nutrition education in concert with its managed plan.
The trust is presently reviewing the opportunity to include some additional benefits, such as expanded vaccine coverage and more targeted health asset management services based on its overall program health.
Leanne MacFarlane is a pharmacist and senior director, business development, with MHCSI Managed Health Care Services Inc. leanne.macfarlane@mhcsi.ca
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