Incorporating diversity, equity and inclusion in drug plan design

“I think what led to this is there’s been a series of events and social movements that disrupted the Canadian landscape over the past 18 months, triggering the need for organizations to adopt and develop a robust equity and inclusion strategy,” said Joanne Jung, pharmacy practice leader at Willis Towers Watson, during a session supported by Novo Nordisk at Benefits Canada‘s Face to Face in Drug Plan Management Forum in December.

Read: Working for organization that values DEI issues important for 71% of employees: survey

She recommended plan sponsors assess whether their benefits programs are aligned with their DEI strategy, looking at each of their benefits lines through the lens of DEI to determine if anything needs to be changed or added to better reflect the diversity of the workforce and ensure their benefits are inclusive and equitable. This might require modernization of traditional plans, said Jung, describing an organization that enhanced their family planning benefit, which included fertility and reproductive aids, as well as coverage for doulas and support for surrogacy and adoption.

Plan sponsors should also analyze their drug plan design to ensure it aligns with their DEI commitment, she said. “I would suggest conducting a very thorough review of drug plan coverage and find out what’s covered beyond the core offering.”

Most plans have lifestyle categories that define coverage for drugs used in smoking cessation, fertility, sexual dysfunction and obesity. Standard coverage may vary by insurer and often plan sponsors can choose to include or exclude these categories.

If a plan is adding certain procedures, Jung recommended they ensure associated drugs are available through the drug plan. For example, some insurers don’t standardly cover drugs for gender affirmation, but if a plan sponsor chooses to add coverage for the procedures, it should validate that the necessary drugs are covered.

Read: KPMG supporting workplace diversity, inclusivity with gender affirmation policy

Before making changes, she suggested plan sponsors consider the geographical distribution of their employees to understand what’s covered by each provincial health plan and supplement accordingly. In addition, she recommended that when plan sponsors consider including additional drug categories as supplemental benefits coverage, they also ensure that, if there’s a maximum, there’s sufficient coverage to access the needed therapies.

Jung also suggested plan sponsors assess if their coverage for obesity treatments aligns with their DEI strategy. Many plans exclude drugs for obesity under the lifestyle category or, if they’re covered, the maximums are very low. “Understanding of obesity has evolved,” said Jung, noting it’s no longer considered a lifestyle choice, but rather is now medically recognized as a chronic disease that’s unfortunately associated with considerable stigma.

“Treating obesity will help mitigate other comorbidities,” she said, noting plan sponsors should consider covering obesity treatments “just as you would other chronic conditions. Don’t assume that your plan is covering drugs for obesity.”

Plan sponsors that want to integrate DEI into their benefits plans may be concerned about the affordability of the additional coverage. However, there may be tradeoffs that can generate savings, said Jung, such as policies that switch biologic patients to lower-cost biosimilars or product listing agreements with pharmaceutical manufacturers.

If plan sponsors look at their situation holistically, she said, they can “save in certain areas and use those savings to enhance other benefits,” so the changes don’t result in an overall net increase.

Read more coverage of the 2021 Face to Face in Drug Plan Management Forum.