New Alliances for a New Foundation (Gary Coles)

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Transcript New Alliances for a New Foundation (Gary Coles)

Working Together for a
New Foundation
Pharmacy Solutions in
Drug Plan Management
October 22, 2014
Gary Coles, SVP, Group Administration
Why Cooperate
 Today’s reality – Private payer plans under pressure
 Cost growth remains higher for private payers than what the
provincial public plans are experiencing
 Long term sustainability is not assured
 Employers want aggressive cost management in response to general
cost increases, as well as trend towards shifting of costs from
hospitals to private payers
Note: competition lawyer present at all working group meetings
Where Did This Lead Us
 Insurers are actively promoting numerous drug plan
management solutions to clients
 Preferred Provider Networks
 Cost controls at point of service – maximum drug pricing,
limitations in mark-up, frequency of dispensing
 Pharmacy agreements
 Strategies to eliminate waste – Extending supply,
Therapeutic Substitution, lower cost alternatives, promoting
 Case management – including health coaching
 Insurers cannot implement these solutions without
Pharmacy partnership
Making the Co-operation Work
In June
2013, CLHIA released a Prescription Drug Policy paper
– 1 recommendation was that there be a continued, thoughtful
expansion of the scope of practice for Pharmacists
• 9000 Points of Care
• Creation of the Pharmacy and Health Insurance Steering Coalition
– Mandate: Facilitate ongoing discussion between senior
representatives of private sector insurers and pharmacy
– Objectives: Identify Common Areas of Interest and opportunities
to collaborate
First Steps
• First Priority – expanding Covered Pharmacy Services
• Creation of a Services ‘tool-kit’
• Developing Reasonable and Customary Guidelines
• Using Health Spending Accounts (HSA) as the Entry Point
How you can get Involved
• Communicate the Benefits
• Promote the Services
• Develop the Support Necessary to Provide the Services
• Provide value to your Clients