Product Modernization

The view from warp speed...

Brad Fedorchuk, VP, Group Marketing

Ah, the group benefits industry. Sometimes when the issues are piling up, when the questions are pouring in, exceptions need to be handled, and with today’s reality of constantly being busy, it feels like the world and our industry are moving at warp speed. 

Of course, the reality is things also move slowly enough that it’s hard to understand how we can’t keep up. Whether the pace for you right now is fast or slow, there are three major trends that need to be considered in plan design:

Generics

It seems like forever ago that the Competition Bureau published a report suggesting that generic drugs were over priced because the market wasn’t competitive. Provincial drug reforms have been going on ever since with reactions from all sides. Many generic drugs are now priced at between 18 and 35% of their brand name counterparts.  Brand name manufacturers have combated with ‘coupon cards’ that will pay the cost differential between the brand and generic version. A policy in the case of generic drugs has always been a good idea but today it’s not something a sponsor should ignore. Without a policy sponsors are incurring between 4 and 6% more on their drug spend. All provincial government programs use generics first. Opinion is split as to whether a generic policy is modern or not, it’s fair to say that a plan absent of a policy is living in an outdated environment.

Specialty Drugs

There’s no standard on these drugs, but they share some common characteristics:

• They’re often the last therapy option. Other treatments have failed, and these drugs often represent the last hope for a patient who is very sick.
• Often very, very expensive – $30K or more a year is common and costs can reach to upwards of $600K - and these are chronic conditions, meaning the expense is ongoing.
• Provincial coverage is partial at best. A longer discussion for another time, but this is an area where it seems some still believe someone else will cover it. 

Use of these drugs has increased over the past several years and is growing faster than other areas. With that in mind, no sponsor should be without a policy on these drugs. 

Many group plans don't include consideration
of health and wellness policies

Do you want your plan to provide the best coverage for minor ailments, or for protection from chronic disease that could financially ruin someone, or much worse, force someone to go untreated? 

Regarding employee health, there’s a decision to be made. Many employers have workplace health and safety policies but many recently-implemented group plans do not include consideration of health and wellness policies. 

More resources are available from insurers and other sources than ever before - the opportunities to review and modernize have never been better. 

In terms of plan you should consider:

• How a policy on generic drugs can positively impact a plan.
• Specialty drugs are expensive but insurable. Do you want the best coverage for cough syrups or for cancer treatments?
• If you could prevent just one employee’s diabetes from progressing further would you take action?

These questions reinforce the need to set clean policies and luckily, there are many resources available to help answer them.

Do you want to have claims managed without seeing if the treatment is working or being complied with? At $30K a year, that is a lot of expense to go unchecked. Patients have a responsibility to use their medications properly. These, and other questions, are central to developing a clear policy on high cost medication.

Seize the opportunity to achieve modern plan management

Health strategies

Many medications help people stay healthy. Some, but not all diseases are either preventable or manageable so a serious health condition is prevented. What about screening to detect pre-diabetes, hypertension, or high cholesterol? These aren’t easy processes to implement but can help with improving plan member health, rather than relying on medications only. What about follow-up? After medication is prescribed who’s ensuring the patient is taking them correctly? Does the patient need help, or maybe a different medication that’s easier to take?

These three trends present a lot to think about but solutions are available that are easy to incorporate. Seize the opportunities to achieve modern plan management.

GroupNet Text is here!

Canadians send 274 million text messages every day.

When something’s this popular, you have to be part of it!

Great-West’s just-released GroupNet Text gives plan members access to their benefits plan details through text messaging.

GroupNet™ Text  provides plan information on mobile devices including:

• Plan number and member ID
• Coverage details*
• Co-insurance amount
• Benefit maximums, balances and more.

To sign up for GroupNet Text, plan members can log on to Great-West’s GroupNet for Plan Members and update their selection in the Your Profile tab. Click here to visit GroupNet now!

*Plan details available depend on plan design. Compatibility of GroupNet Text may vary by mobile device and/or operating system. Charges may be incurred depending on the user’s cell phone contract.

Shopping With Someone Else’s Money

Generally speaking, when you purchase a product, you research, compare, make the decision, and finally, pay for it. Of course, a big part of the process is shopping for the best price. 

Compare this to the process of getting a prescription drug. It’s kind of like shopping with someone else’s money.

Role                             Played by

The consumer              The patient

The decision maker      The doctor

The payer                     The employer’s group benefits plan

Essentially, the consumer is prescribed a drug by the decision maker. The consumer gets the prescription but all or most of the cost is absorbed by the employer’s group benefits plan. Consumers don’t have to shop for the best price – they might not even know that prices on prescription drugs vary, or they might feel that cost doesn’t matter because they’re only responsible for paying a small portion of the cost. As a result, the payer, (the employer) pays, but hasn’t had any say.  

Sometimes when doctors ask “do you have a drug plan?” it’s their way of asking “do you care how much this costs?” Let’s be fair. Doctors aren’t trained in the world of group insurance, or the impact of claims experience on premiums - this doesn’t fall under the umbrella of their responsibilities. But we’re working to make an impact where we can. When asked, one of our goals is to change the way patients answer this question. 

From the sponsor’s perspective, it’s complex. They want to provide a plan that’s both comprehensive and sustainable, but they’re struggling with the affordability. Plan sponsors fund drug plans, but have had little control over the actual payment process - until now. 

We’re prepared

We’ve developed DrugSolutions, a series of drug plan management options and solutions that focus on balancing the cost to the plan sponsor with the health care needs of their employees. Options and solutions include:

Enhanced Generic Substitution – Generic versions of brand name drugs can cost as little as 18 per cent of the brand name. With Enhanced Generic substitution implemented into a plan design, reimbursement of a drug claim is limited to the cost of the generic equivalent. 

Health Case Management – Taking specialty medications can be overwhelming. Unfamiliar terms, instructions and side effects, can be stressful. This program provides support to enhance the patient’s experience and help him or her understand and adhere to the treatment plan. 

Balance

We’re listening carefully to the concerns of plan sponsors and including their voice in the drug purchasing conversation. Implementing new plan design options can bring balance to contributing to better health outcomes and quality of life, while reducing the cost assumed by plan sponsors.

Barb Martinez, 

Practice Leader, Benefits Solutions

Diabetes – The Burden in Canada

While diabetes can take a serious toll on a person’s health, it also carries a heavy financial burden.

The Canadian Diabetes Association estimates that by 2020, diabetes will cost the Canadian health care system $16 billion a year. People with diabetes incur medical costs that are two to three times higher than non-diabetics. A person with diabetes can face costs for medication and supplies ranging from $1,000 to $15,000 a year.

Although diabetes has traditionally been thought of as an older person’s disease, more than 50% of Canadians diagnosed with diabetes are of working age – between 25 and 64 years old – according to the Public Health Agency of Canada. As a result, diabetes rates also have an impact on employee absence, disability and benefit plan costs.

The greatest relative increase in diabetes rates is seen in the 35-to-39 and 40-to-44-year-old age groups. This increase in younger age groups is, in part, likely due to growing levels of overweight and obesity. Adults who are obese are two to four times more likely to have type 2 diabetes.

The Need for Industry Pooling on High Cost Drug Claims

The high cost drug landscape

Over the past decade, on average, prescription drug plan costs have increased between 9-12% each year. These increases have largely been driven by blockbuster drugs such as Lipitor and Crestor.  However, the face of the prescription drug landscape is changing.  Recently, cost increases have slowed due to drugs coming off patent and legislative changes to generic drug prices. Meanwhile the cost and claiming frequency of high cost biologic drugs continues to increase.  

In fact, according to our 2010 data, the total annual cost associated with specialty medications was 97% of the total annual cost of acute medications (such as antibiotics). Based on our figures, the average annual cost per claimant for specialty medications claims is over 136 times higher!

Medical advances have led to a significant increase in the number of high cost prescription drug therapies.  Although their annual costs can be considerable (sometimes well over $50,000 per year), these medications are often life-changing. 

Forecasted growth in the number of high cost drugs available and prescribed in the Canadian market is causing concern among plan sponsors and insurers. This scenario could result in strain for both the plan sponsor trying to control the rising cost of a renewal, and the plan member who may be facing a reduction in coverage of his or her drug therapy.  Given the life-changing nature of these blockbuster drugs, we believe the best approach to managing these costs is the combination of a strong prior authorization process and a mechanism to spread the potential costs across the industry.

The industry solution

Canadian life and health insurers have come together to offer a new drug pooling framework, designed to help protect private benefits plans from the impact of high cost drugs.

More Ways to be Mobile

You're on the go - so are we!

GroupNet Mobile - available for your Android device, BlackBerry and iPhone. Same great app, three different ways to connect!

GroupNet™ Mobile, Great-West Life’s free mobile app, lets you use your Android device, BlackBerry or iPhone to:

• Submit claims online with Member eClaims – part of our industry-leading GroupNet online services
• Access personalized coverage information about your benefits, claims and more – quickly and easily, any time
• View card information including: member ID, Drug, and Global Medical Assistance
• Locate the nearest provider who has access to Provider eClaims through a built-in GPS mapping tool.

Click to visit the iTunes App Store - GroupNet Mobile for iPhone

Click to visit the Google Play Store - GroupNet Mobile for Android

Click to visit the BlackBerry App World - GroupNet Mobile for BlackBerry

For more info, please visit the GroupNet section of the Great-West Life website. 

GroupNet Mobile for iPhone