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Solution in Drug Plan Management 2011 September 8, 2011 Basil Rowe Vice President, Total Rewards and Shared Services Shoppers Drug Mart [email protected] More Ways To Care, More Ways to Benefit SDM implemented in January 2011 a new leading edge benefits plan Formulary Solutions Wellness Solutions Chronic Care Solutions Plan Spending Enrolment in mentored and self-help programs Participation in Diabetes Management Program -14.7% 20% 40% The Case for Change SDM average amount per claim was above benchmark for its corporate plan and below benchmark for its retail plans. Benefit plans were inconsistent and inequitable across employee groups SDM wanted to group all SDM employees under one best-in-class plan SDM Corporate Plan There was a desire to leverage organizational capabilities to offer value-added services Benchmark SDM Retail Plans Year 2009 One Employer’s Reality 2010 Review Learnings 2012-13 Growth: 7% Corporate Trajectory prior to provincial reforms Central office employees’ plan design was not optimized 2012-13 Growth: 7% Impact of legislative changes and genericization of blockbuster drugs 2009(A) 2010(F) 2011(F) 2012(F) 2013(F) Increased genericization and a decrease in generic drug prices would only provide temporary savings Change was required Our Path To Success Defining Solution Implementing Monitoring Communicating Defining Solution Objectives and Opportunities Objectives What are my goals? Opportunities What are my cost drivers? Improve the health of our employees and their families Chronic Conditions & Rare Diseases Reduce the cost risk to the organization Open Formulary & Specialty Drugs Engage, empower and share accountability for better health Lack of Coordination of Benefits Integrate our benefit offering Drugs & Short and Long-Term Disability Defining Solution From Ideas to Solutions – Previous Plan Manage Risks Change Behaviours Open Formulary Lower Cost Alternative (LCA) Utilization management EAP Manage Future Costs Defining Solution From Ideas to Solutions – Current Solutions Formulary Solutions Wellness Solutions Chronic Care Solutions Custom formulary managed in-house Health risk assessment Diabetes Tiered copay Mentored and self-help programs Rheumatoid arthritis Generic leadership Mental health & stress triage and referral to EAP Multiple sclerosis Utilization management Personal wellness account & incentives Cancer Implementing Balancing the Experience of Members and Employer Generic Leadership P&T Committee Pharmacy Expertise L&D Incubator Pharmacy Training GrandFathering Consistent Experience Human Resources Perspective 1-800 Number Drug Lookup Tool Communicating Engaging Members at Home, at Pharmacy, at Work Plan Documentation Customized Branding Branded Drug Card Targeted Mailings Launch Video Town Halls Screensavers Newsletters Wellness Contest Drug Lookup Tool In-Store Handouts Communicating Engaging Members at Home, at Pharmacy, at Work CUSTOMIZED BRANDING SCREEN SAVER DRUG LOOK UP TOOL KIT BENEFITS AT A GLANCE WELLNESS CONTEST BRANDED DRUG CARD NEWSLETTER POSTERS Monitoring Focusing on Outcomes for Future Improvements Our goal is to have an integrated view of our benefits investments and to be proactive in improving our plan Sample Scorecard Trend Member Experience Survey Benefit Design Average amount paid per employee Average amount paid per claim Average number of claim per employee YOY growth in average $ per employee 45% of employees participated in the postenrolment survey Drug / Prescription Coverage ranks as #1 in importance COB % of total eligible amount % of 90 Day fill for Maintenance Drugs Savings from Tiered Co-Insurance Formulary Savings from Managed Formulary Generic Penetration OTC % of total amount paid SRx % of total amount paid Other In-Network Usage 88% of employees find that the plan is more sustainable for the company in the long term Employees found communication effective – but needed more information on how to make better use of their benefit choices From LCA to Generic Leadership Increase price differential through tiers Lower reimbursement for unique drugs with generic in therapeutic class Monthly reporting on generic penetration and efficiency Opportunity report Results: +8% in generic penetration Defining Solution Monitoring Implementing Grandfathering of members on non-preferred drugs Best in class generic dispensing at pharmacy Communicating In-store handouts Direct mailing Newsletter Drug Lookup Tool More Ways To Care, More Ways to Benefit Our People Our 6-Month Results Plan Spending -14.7% Generic Penetration +8% Enrolment in mentored and self-help programs 20% Participation in Diabetes Management Program 40% Our Future Medication Review & Retroactive DUR Expanded Specialty Disease Management Step Therapy Lessons Learned Focus on Members Experience Change Management Engagement Integrated Information Monitor Results Opportunity Analysis Experience Survey Scorecard Access Pharmacy Expertise Health Care Knowledge In-Store Feasibility Industry Dynamics