Group insurance. Drug insurance Integrated plan management solutions

Transcription

1 Group insurance Drug insurance Integrated plan management solutions

2 Our vision We are a Canadian leader in group insurance recognized for our optimal approach to health management, our close client relationships and our membership in the Desjardins family. It s what sets us apart, and it helps us create a distinctive client experience and lasting partnerships with our advisors and plan sponsors.

3 Sound management practices for effective results Nearly half of all health insurance benefits paid out in Canada in 2013 were for prescription drugs. 1 So it s in everyone s best interests to make sure that money is spent wisely. We know your employees health is important to you and so is the financial health of your company. So we ve developed a number of measures to help you manage your group drug plan as effectively as possible. The solutions covered here will give you more control over the reimbursement process for drug expenses. It s a way for us to help you care for your employees health and optimize your investment. Most of the measures described here require a payment card. 1 CLHIA, Canadian Life and Health Insurance Facts, 2013 Edition.

4 Plan member education a winning strategy It s important for plan members to understand that their decisions have a real impact on the cost of their group insurance plan. So we have created a special section on our website that clearly explains how to use drug insurance benefits responsibly. It is written in plain language and includes concrete examples, straightforward solutions, and entertaining educational videos. It encourages plan members to make financially responsible decisions about their drug insurance benefits, without compromising their health. The Web page is accessible to everyone at desjardinslifeinsurance.com/ en/group-plans/responsibleuse-drug-insurance. Drug cost simulator This online service is an excellent complement to our other costcontrol measures. Accessible from the plan members secure site, it is an informative awareness-raising tool that helps plan members make responsible choices when buying prescription drugs. In just a few clicks, they can: Find out if a drug is covered under their plan Estimate how much they will have to pay for it Compare the cost of the drug to less expensive generic equivalents The drug cost simulator is a double source of savings for both your employees and your plan. It actively promotes the use of generic drugs with concrete evidence of its financial advantages; and it shows insureds how prices can vary by comparing what they d pay at their usual pharmacy to the average market price. This tool is included in all our group plans that use payment cards. As soon as members sign up to use the secure site, they can access the tool free of charge. 2

5 Encourage employees to shop around Contrary to what many people believe, prescription drugs don t cost the same everywhere. This is primarily because mark-ups and dispensing fees vary from one pharmacy to the next. The total drug cost is made up of the following elements: 2 Total prescription cost = Drug cost + Mark-up + Dispensing fee Total amount billed Price paid by the pharmacist to obtain the drug A percentage of the drug cost charged by the pharmacist to cover, among other things, the pharmacy s operating expenses Fee charged by the pharmacist for their professional services This example illustrates why we suggest you introduce caps on mark-ups and dispensing fees. Our standard caps are set by province and revised regularly. They help control costs with minimal impact on your employees. Caps encourage them to shop around for the best price at the pharmacies that offer the services they need. They also help keep your drug insurance costs in check. 2 In Quebec, invoices aren t broken down into these categories. 3

6 Generic drugs: a smart choice The majority of health insurance expenses are for drug costs, and these costs are on the rise due to an aging population, an increase in chronic illness and the introduction of new high-cost drugs. Generic drugs can cost 65% to 82% less than their brand name equivalents reason enough to encourage their use. We recommend that drug plans include mandatory generic substitution, which calculates reimbursements according to the cost of the least expensive generic equivalent available on the market. This example shows how choosing a generic drug can yield cost savings for your employees and your plan. Generic drug Brand name drug with a generic equivalent Brand name drug without a generic equivalent Total cost of prescription submitted by pharmacist $25 $100 $150 Cost of least expensive generic equivalent $25 $25 N/A Amount paid by Desjardins Insurance (80% of cost of least expensive generic equivalent) $25 X 80% = $20 $25 X 80% = $20 $150 X 80% = $120 Amount paid by insured $25 - $20 = $5 $100 - $20 = $80 $150 - $120 = $30 In Quebec, the reimbursement amount cannot be lower than the minimum set by RAMQ. A mandatory generic substitution plan with standard caps on mark-ups and dispensing fees can yield savings of up to 3% on drug claim costs. 4

7 Tiered plan with Dynamic Therapeutic Formulary This two-tiered approach encourages plan members to choose equally effective, lower-cost medications while ensuring they still have access to other prescription drugs covered by their plan if they need them. It educates plan members about the cost of drugs and encourages them to actively participate in the decision-making process. This solution is available as an add-on. Tier 1: Our partner, Express Scripts Canada (ESC), has created a Dynamic Therapeutic Formulary (DTF) that includes about 85% of all prescription drugs available on the market. Plan members will get the highest reimbursement percentage for these drugs. Tier 2: We offer a number of lists that include all the drugs that are not on the DTF. Plan members will get a lower reimbursement percentage for these drugs than they would for Tier 1 drugs. Both tiers have mandatory generic substitution. The DTF is updated regularly. Each month, an expert committee at ESC reviews new drugs that come onto the market to determine whether they should be added to the list, and twice a year ESC conducts a full review of the list. This type of plan can generate savings of up to 6% on drug claim costs. 5

8 Prior authorization drugs We collect additional information to confirm that prescription drugs are being used for their intended purpose and that they meet our prior authorization criteria. These criteria are similar to those used by provincial drug insurance plans and they take into account drug uses recognized by Health Canada, as well as information from drug manufacturers. This program reduces drug claim costs by ensuring plan members receive the most suitable and cost-effective treatments. It is included in all our group plans and it can generate savings of 1 2% on drug claims costs. 6

9 Active Pharmacy This practical solution was designed to change plan member behaviour by encouraging them to make better health decisions, which will reduce their costs as well as yours. This solution 3 is available as an add-on, and its features include: You can reduce your expenses for maintenance drugs used for chronic illnesses by 10%. Delivery of maintenance drugs 4 to the plan member s home or an address of their choice A single dispensing fee for a 90-day supply Increased use of generic drugs A choice of more cost-effective alternative therapies plan members can discuss with their attending physicians Renewal of maintenance medications online, by phone or by mail Automatic reminders and renewals to help ensure plan members keep an adequate supply of medication on hand and adhere to their treatments Pharmacist on call 24/7 to answer questions in strict confidence 3 Not available in Quebec. 4 Prescription drugs that treat chronic illnesses such as asthma, diabetes, high cholesterol and high blood pressure, which account for more than 50% of all drugs claimed. 7

10 Real-time intervention at the pharmacy We automatically include the following specialized programs that help safeguard your employees health while controlling your healthcare costs. Drug utilization review program (for point-of-sale electronic transactions) In less than five seconds, pharmacists can see: Dangerous drug interactions Duplicate therapies If the same drug has been purchased at multiple pharmacies If multiple healthcare professionals have prescribed the same drug Drug misuse (including overconsumption) Inappropriate supplies Concurrent therapies Specialty drug and hospital drug programs These programs ensure private plans don t cover drugs that could be covered by provincial plans or administered in a hospital. If a plan member gives their pharmacist a prescription for a specialty drug that is covered by their provincial plan or that would usually be administered in hospital, the computer system will notify the pharmacist that the drug is not eligible for reimbursement. In such cases, the pharmacist will ask the plan member to call our Customer Contact Centre for more information. Early renewals This program can generate savings of 2 3% on drug claim costs. 5 The hospital drug program can generate savings of 1-2% on drug claim costs. 5 5 Based on Express Scripts Canada data. 8

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12 About Desjardins Insurance Desjardins Insurance has been offering a wide range of life and health insurance and retirement savings products to individuals, groups and businesses for more than a century. As one of Canada s five largest life insurers, they oversee the financial security of over five million Canadians from offices across the country. Desjardins Insurance is part of Desjardins Group, the country s leading cooperative financial group. Do not hesitate to contact us for additional information on our products and services. Desjardins Insurance Vancouver Calgary Winnipeg Edmonton Toronto Ottawa Montréal Québec Halifax St-John s Visit our website at desjardinslifeinsurance.com Desjardins Insurance refers to Desjardins Financial Security Life Assurance Company E (15-06)