Now that the marketplace has moved past the golden era of drug plan management, where one could do nothing and see cost trends level off (or decline), it comes as no surprise that fear is setting in as the reality of cost increases set in.
Earlier this week, Manulife announced it’s 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.
NDP leader Tom Mulcair went to a Liberal-held riding today to announce he plans to work with the provinces to support universal prescription drug coverage—but the party is not classifying their promise as a national pharmacare plan.
At 11.59%, the overall average health trend factor will continue in the same range this year as it has for the last four years, says the 2015 Accompass Guide to Health and Dental Trends, which polled nine insurers.
Saskatchewan, British Columbia, and Manitoba have all announced that they are adding new generation hepatitis C drug Holkira Pak, to their respective formularies, which also include hep C drugs Harvoni and Sovaldi, says Accompass.
It’s interesting to watch how product and service development, and the marketing of these offerings, takes place in the group benefits industry. Products and services routinely seem to be developed based on perceived need and often don’t appear to have been thoroughly vetted by the end customer: plan sponsors. Once an offering is released into the market, there seems to be a subsequent rush of competitors looking to bring similar offerings to bear primarily to make sure they can check off the same capabilities boxes, as opposed to focusing on actual need and approach.
With a stream of new biologics coming to market, a wide variety of programs and services are available to support patients taking these high-cost specialty drugs. A panel discussion moderated by Michael McClenahan, CEO of Benefits by Design, explored the pros and cons of these new programs and their impact on private drug plans.
David Willows, vice-president, strategic market solutions, with Green Shield Canada (GSC), shared findings from GSC’s 2014 health study. As he explained, this was the first time the annual study went beyond just drugs to create a bigger picture of employer-sponsored health benefits consumption in Canada. Drawing on a database containing millions of health claims, the study breaks down the volume and cost of claims for drug and paramedical health benefits consumed by Canadians in age bands ranging from birth to retirement.
Year after year, the drug plan industry studies trends in utilization and costs with an eye on what’s coming next.
The future of medicine will be data-driven and focused on creating personalized medicine for each patient based on their individual molecular profile, according to a paper by The Personalized Medicine Initiative and PwC Canada.