Manulife is changing the way it will evaluate new drugs coming to the market to help plan sponsors contain rising drug costs. This means plan members who have been prescribed certain new drugs will see their drug claims denied until Manulife evaluates the drugs and decides whether to provide reimbursement.
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Effective immediately, the new drug evaluation program will determine whether new, more expensive drugs produce sufficient additional health outcomes to justify the higher cost.
Repatha, approved by Health Canada on Sept. 10, 2015, is one drug that is impacted is immediately. The high-cholesterol medication is the first new medication Manulife will evaluate, so until the insurer assesses this drug, it won’t reimburse plan members who make a claim for it.
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The same goes for and any future drugs included in Manlulife’s new oversight program, called DrugWatch: claims made for those drugs will initially be denied, explains Jan Foster, Accompass associate vice-president. The drugs will be denied initially even if they have been prescribed by a physician and approved by Health Canada, Foster adds.