Ask The Expert: Private Insurance
Education and Advocacy Barbara Martinez of Great-West Life addresses the sustainability of private insurance against rising drug costs.
How are insurance companies working with employers to help manage drug costs?
Some conditions, like rheumatoid arthritis, can be treated with a number of different medications for which cost differences can vary by more than $10,000 per year. Doctors may not be aware of these variances and as a result, may not consider if the patient can achieve the same health outcome with a lower cost option.
Insurers have responded with service agreements like preferred pharmacy networks to help employers better manage drug plan costs. In 2012, Great-West Life engaged a preferred pharmacy network manager to help us pioneer a health case management program in Canada for clients’ employees who are prescribed certain specialty drugs. This patient-centered approach helps ensure that lower cost options are considered, if appropriate for the patient’s condition.
Patients are connected with a health case manager who works with them and their physicians to monitor and confirm that the treatment is working. Patients are empowered to participate in managing their condition through education and lifestyle changes.
To date, preferred pharmacy networks have helped achieve significant cost savings annually for our clients, and in some cases even reduced out-of-pocket expenses for their employees.
What can employees do to help keep benefits plan costs down and sustainable into the future?
Without coverage through a group benefits plan, payment for medications and health care services comes out of employees’ pockets. Many couldn’t afford to pay the average annual cost of health care benefits*, so we all need to do what we can to help sustain this coverage, today and into the future.
How to help:
■ If you take medication for a chronic condition, order a three-month supply rather than a one-month supply three times. This way, only one dispense fee is charged by the pharmacy, rather than three.
■ Opt for a generic version of your medication. Generics contain the same medicinal ingredients as their brand-name counterparts and come at a much lower cost.
■ Take care of your health. Be involved in your treatment plan. Take medication as prescribed, eat well, and participate in wellness programs.
Helping to keep employees informed and educated is just one aspect of Great-West Life’s work to support the financial, physical and mental well-being of Canadians.