Private drug plans play a pivotal role in ensuring faster and broader access to medications for 27 million Canadians, said Joe Farago, executive director of private payers and investment at Innovative Medicines Canada, during Benefits Canada’s 2024 Face to Face Drug Plan Management Forum.
The federal government’s new pharmacare plan is designed as a universal, single-payer public system that excludes private insurance, he noted, which poses a potential threat to private coverage and the benefits it provides to Canada’s working population.
Private plans list drugs three-times faster than public plans — 226 days compared to more than two years — and typically cover twice as many medications, providing broader listing criteria that ensures the right medicine reaches patients when they need it most.
Read: Innovative Medicines Canada calling on feds to clarify impact of pharmacare on private drug plans
Timeliness matters, he said, especially for those facing critical health conditions. “Does it really matter that they list faster? It matters if you’re the patient or if your spouse needs access.”
Many private plans have changed the way they’re assessing drugs, noted Farago, which erodes the value of employer-sponsored drug coverage. Private plans that reference public health technology assessments can have a significant impact on drug access.
Referring to a survey of Innovative Medicines Canada’s member companies, he said half of respondents indicated it was common for insurers to wait for public drug plan coverage decisions before completing their drug reviews.
“Looking to public drug plans is probably not the most appropriate way to be evaluating drugs for private drug plans. Public plans serve a distinct population and have different objectives than private plans. Public plans primarily focus on providing coverage for seniors and low-income or vulnerable Canadians, whereas private plans serve working Canadians and their families, targeting a generally younger population with an emphasis on productivity.
Read: Collaboration key in maintaining value of private payer health care: experts
“Although proper due diligence is important, we can’t afford to have private drug plans move as slow as the public plans or we run the risk that the value of the private market slips away.”
Farago suggested private plans assess new drugs based on their impact on the working age population to ensure they contribute to a healthy and productive workforce.
Streamlining listing processes and fostering dialogue around drug evaluation practices are paramount to safeguarding the value of private drug plans, he added, noting collaboration will ensure Canadians enjoy the advantages of private plans and their ability to offer quick, comprehensive coverage that strengthens Canada’s workforce and their families.
Read more coverage of the 2024 Face to Face Drug Plan Management Forum.