With ever-bloating drug plan costs, sponsors need bite-sized solutions to get costs under control
Not long ago, drug cost management typically entailed reductions in coverage for plan members in the form of lower coinsurance, increased deductibles, dispensing fee caps, etc. It wasn't so much cost management as simply cost shifting from employers to employees.
Starting next month, Green Shield Canada is limiting new prescriptions of high-cost drugs to 10 days under its initial days supply feature.
Much has been written over the last 36 months with respect to programs that have been implemented to help contain and manage drug plan costs. Carriers, claims processors, benefits consultants and plan advisors have all invested significant resources into building out solutions for plan sponsors in this area. The wave of investment and focus was long overdue and is great to see. It’s also encouraging to see that plan sponsors and the key stakeholders who service them recognize that this golden age of flat trends in healthcare costs for plans will be short-lived as both utilization and cost pressures rise in unison.
While the rising cost of prescription drugs has slowed over the years, it's likely to increase at a faster pace in the future.
Solutions to rising drug costs and unequal drug coverage are never easy. But that shouldn’t stop stakeholders from examining these issues to determine what can be done to improve the current system.
I recently had a discussion about business models and compensation structures within the financial services world with a few of the students in the finance elective class I teach at the University of Waterloo. The conversation centred around how widely accepted reimbursement models have evolved in various areas of the financial services sector, and how they didn’t always appear to make tremendous sense on the surface or seemingly add much value for the client.
The money spent on pharmaceutical treatment in Ontario more than pays off in savings for the health system and improved productivity for the economy, according to a report.
Ten years ago, prescription drug prices in Canada were essentially shrouded in mystery. Canadians who purchased drugs on a regular basis may have been aware that the total retail price paid at the pharmacy consisted of the ingredient cost plus the dispensing fee (the professional fee pharmacies charge to dispense medication and advice). In most provinces, these two price components are clearly disclosed on the official drug receipt.
The Canadian Life and Health Insurance Association says the prescription drug system must be fundamentally reformed if it is to serve Canadians well in the long term.