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Posted by Medavie Blue Cross on January 12, 2023
The hefty price tag of prescription drugs ― particularly high-cost specialty drugs ― is challenging those footing the bill to seek new and innovative ways to bring costs under control, while continuing to protect the health of Canadians.
Posted by Medavie Blue Cross on January 12, 2023
The hefty price tag of prescription drugs ― particularly high-cost specialty drugs ― is challenging those footing the bill to seek new and innovative ways to bring costs under control, while continuing to protect the health of Canadians.
Specialty drugs to treat rare and common conditions, such as asthma, severe eczema, cholesterol and Alzheimer’s, are a major contributor to that total. They have an average annual treatment cost greater than $10,000 and now represent 29% of total drug spend nation-wide, which is consistent with our own data.
As the manager and insurer of benefits for 1 in 10 Canadians, helping our clients strike that all-important balance between sustainability and access to care has always been a top priority. Drugs make up 65% of our total health spend, with chronic conditions like diabetes and cardiovascular disease being the biggest drivers.
Specialty drugs to treat rare and common conditions, such as asthma, severe eczema, cholesterol and Alzheimer’s, are a major contributor to that total. They have an average annual treatment cost greater than $10,000 and now represent 29% of total drug spend nation-wide, which is consistent with our own data.
As the manager and insurer of benefits for 1 in 10 Canadians, helping our clients strike that all-important balance between sustainability and access to care has always been a top priority. Drugs make up 65% of our total health spend, with chronic conditions like diabetes and cardiovascular disease being the biggest drivers.
We draw on our unique capabilities as an integrated all-in-one pharmacy, health and disability benefits insurer and PBM (Pharmacy Benefit Management (PBM) claims adjudicator, to support private and public sector clients across Canada in managing drugs effectively and sustainability — backed by our Medication Advisory Manel (MAP), which critically assesses new medications coming to market and their effects on existing coverage.
Their clinical expertise, along with those of our in-house PBM specialists, are foundational to our PBM and insurer solutions, together with other core capabilities like our technological innovation and integration, strategic relationships, pharmacy channel partnerships, and data insights that drive positive outcomes.
We draw on our unique capabilities as an integrated all-in-one pharmacy, health and disability benefits insurer and PBM (Pharmacy Benefit Management (PBM) claims adjudicator, to support private and public sector clients across Canada in managing drugs effectively and sustainability — backed by our Medication Advisory Manel (MAP), which critically assesses new medications coming to market and their effects on existing coverage.
Their clinical expertise, along with those of our in-house PBM specialists, are foundational to our PBM and insurer solutions, together with other core capabilities like our technological innovation and integration, strategic relationships, pharmacy channel partnerships, and data insights that drive positive outcomes.
You can see this reflected in solutions, such as Rxperience, our intelligently managed and comprehensive drug plan. Representing a new standard in flexible, optimized drug coverage, Rxperience draws on our experience, expertise and deep understanding of our clients’ needs to achieve the right balance of coverage, administration/management and cost savings for plan sponsors and members
• Rxperience offers industry-leading medication coverage for new and emerging treatments, with open coverage for traditional non-specialty benefit coverage and management of specialty high-cost drugs, deemed eligible by our MAP.
• Standard features include Mandatory Generic Substitution for multi-source brand drugs, Prior Authorization for specialty drugs, Specialty Case Management, Biologic Savings Approach our Managing Chronic Disease benefit, glucose monitoring systems, weight loss drugs and more.
Additionally, Rxperience provides:
• Easy ability to layer on optional plan management features that reduce cost, and improve member adherence, safety and care based on plan sponsors’ specific philosophies
Our dedicated Pharmaceutical Partnership Strategy focuses on building business to business relationships with pharmaceutical industry stakeholders, targeting the appropriate use and cost of drugs, to ensure plan members have access to innovative drugs at fair prices, and access to valuable support services. Our MAP review helps us target drugs for negotiations.
We have a robust portfolio of unique product listing agreements (PLAs), negotiated directly with drug manufacturers on behalf of our clients to secure lower net prices. Our PLA approach is delivering savings and value through a range of agreement types, including price discounts, cost sharing and contracted disease management support services for members.
Our leading digital and claims adjudication technologies are developed in-house to enable the development of innovative member support tools and a responsive and flexible point-of-sale claims adjudication system.
Overall, our integrated, under-one-roof business model provides us with the data sets and broader insights into emerging health and drug management trends to guide us in creating unique solutions that meet the evolving needs of all-size clients and enhance employee wellness.
Our dedicated Pharmaceutical Partnership Strategy focuses on building business to business relationships with pharmaceutical industry stakeholders, targeting the appropriate use and cost of drugs, to ensure plan members have access to innovative drugs at fair prices, and access to valuable support services. Our MAP review helps us target drugs for negotiations.
We have a robust portfolio of unique product listing agreements (PLAs), negotiated directly with drug manufacturers on behalf of our clients to secure lower net prices. Our PLA approach is delivering savings and value through a range of agreement types, including price discounts, cost sharing and contracted disease management support services for members.
Our leading digital and claims adjudication technologies are developed in-house to enable the development of innovative member support tools and a responsive and flexible point-of-sale claims adjudication system.
Overall, our integrated, under-one-roof business model provides us with the data sets and broader insights into emerging health and drug management trends to guide us in creating unique solutions that meet the evolving needs of all-size clients and enhance employee wellness.
This article is drawn from information presented by Marie-Hélène Dugal, Manager, Pharmacy Benefit Strategy at Medavie Blue Cross, for the final webinar of our 2022 Insights webinar series. Her presentation, hosted by Tara Anstey, Director, Business Development Client Value, explores the latest trends impacting the drug landscape and the tools manage drug spends effectively and sustainably. If you missed it, or want a refresher, view the webinar recording.
Want to learn even more about learn more about how we are providing cost-effective and sustainable solutions for our clients while delivering positive health outcomes for members? Read all about our Drug Solutions and speak to your Medavie Blue Cross representative to help you make informed, smart choices when it comes to pharmacy, health and disability benefits.
Medavie Blue Cross is a premier all-in-one carrier that provides health, dental, travel, life and disability benefits and administers federal and provincial government-sponsored health programs. Together with Medavie Health Services, we are part of Medavie, a health solutions partner committed to improving the wellbeing of Canadians. We are in the...