News Archive

Program to educate physicians about drugs
Ontario will soon become the fifth Canadian province to launch an academic detailing program to disseminate evidence-based drug information for physicians. Such programs—already running in British Columbia, Nova Scotia, Saskatchewan and Manitoba—are shown to promote better prescribing. The Ontario program, funded by the province’s Ministry of Health and Long-Term Care, is intended to encourage the use of the most therapeutically appropriate and cost-effective medications for each patient; to provide objective, evidence-based comparative drug information to physicians; and to reduce provincial drug expenditures. Source: "Ontario starting academic detailing," Sonya Felix, Drugstore Canada, March 2009, p. 13.

Bill 102 shifting costs to private sector
Ontario’s government has been successful in lowering its drug costs since the Transparent Drug System for Patients Act (TDSPA) was introduced, by reducing markups, limiting generic prices to 50 percent of branded, and tendering generic drugs and pocketing rebates. The bad news is that it’s only getting worse for those responsible for private drug plans, as plan members continue to pay higher prices at the pharmacy. Private plan sponsors need to understand that drug pricing issues are going to be enormously important in managing costs moving forward, and must educate themselves as to how they can participate in the solution rather than be victimized by the problem. Source: "The Financial Fallout of Bill 102 on Private Sector Drug Plans," Mike Sullivan, posted at www.benefitscanada.com, Feb. 23, 2009.

Health Council website to facilitate discussion
The Health Council of Canada has launched a new website (www.CanadaValuesHealth.ca) to provide a forum for individuals, groups and organizations to speak out on the subject of value for money in health care. Designed to engage national dialogue, site content will be generated by participants through a message board, podcasts, blogs, online polls, and research and position papers prepared by stakeholders and interested parties. "Contrary to popular belief, aging and population growth are not the major causes of the rise in Canada’s healthcare spending," says the Council. "In reality, half of the increase can be directly attributed to accelerating use of the system. We have to understand why, question whether we are getting healthier as a result, and come up with new ideas for improving efficiency." Source: "Speaking out about healthcare value," news brief posted at www.chmonline.ca, Feb. 23, 2009.

Consumer survey supports greater role for pharmacists
A new Ipsos Reid survey, conducted on behalf of the Ontario Pharmacists’ Association (OPA), reveals that a majority of Ontarians (71%) believe pharmacists could do more to help them manage their health. More specifically, the respondents said they would depend on pharmacists for providing appropriate medication/advice for minor ailments (89%), adjusting medication formats (84%) and extending prescription refills (67%). The OPA hopes these survey results will help support their case for expanding the pharmacist’s role in Ontario. Source: "Most Ontarians say pharmacists could play greater role," Brett Ruffell, posted at www.pharmacygateway.ca, March 2, 2009.

Online workplace wellness toolkit
Employers nationwide could benefit from a workplace wellness kit and implementation guide, recently launched by the New Brunswick Business Council. The initiative came out of a working partnership between the Heart and Stroke Foundation of New Brunswick, the College of Psychologists and the New Brunswick Department of Wellness, Culture and Sport. As well as focusing on four pillars of wellness (healthy eating, physical activity, tobacco-free living and psychological wellness) the tool kit offers a four-step approach for building an effective business case. The resource is available for free, at: http://www.heartandstroke.nb.ca/site/c.kpIPKZOyFkG/b.4835889/k.95A2/Workplace_Wellness_Toolkit.htm. Source: "Workplace wellness kit launched in N.B.," Sheryl Smolkin, Employee Benefit News Canada, Jan/Feb 2009, p. 13.

Study shows therapeutic substitution adds costs
Although British Columbia’s therapeutic substitution policy was expected to save money for the provincial government, a study analyzing the B.C. Ministry of Health Services’ database from 2003 to 2005 found instead that the policy cost more than $43.5 million and had a negative impact on patients’ quality of life. The study, published in Alimentary Pharmacology & Therapeutics and co-authored by Gail Attara, executive director of The Canadian Society of Intestinal Research, and Dr. James Gray, clinical gastroenerologist and associate professor at the University of B.C., attributes higher costs to additional physician services, more hospital services and higher utilization of proton pump inhibitors. The B.C. government disputes the study findings, stating that it "conservatively estimates that we saved over $22 million." Source: "Therapeutic substitution policy costs B.C. $43.5 million: study," Stephanie Cunningham, posted at www.pharmacygateway.ca, Jan. 29, 2009.

Hewitt opens onsite wellness centre and pharmacy
Employees at Hewitt Associates headquarters in Lincolnshire, Ill., now have access to a number of onsite medical services including health screenings, lab tests, immunizations and allergy shots, and comprehensive health exams. The Choose Health Wellness Centre also features a pharmacy where employees can fill scripts and purchase over-the-counter medications and supplies. Convenient, cost-effective medical and prescription services are intended to help employees improve their health and better manage their own healthcare costs, says Tracy Keogh, senior vice-president, HR, at Hewitt. Source: "Hewitt Opens New Wellness Program Centre," posted at www.benefitscanada.com, Jan. 22, 2009.

Health Council urges action on NPS
The Health Council of Canada’s report, National Pharmaceuticals Strategy: A Prescription Unfilled, highlights gaps between promises made when the strategy was established in 2004 and progress made since then. Released in January 2009, the report reviews the status of initiatives such as catastrophic drug coverage, expensive drugs for rare diseases, breakthrough drugs, pricing and purchasing, analyzing costs, influencing prescribing, e-prescribing, common national drug formulary and real-world drug safety and effectiveness. The report is available for download at www.healthcouncilcanada.ca/docs/rpts/2009/HCC_NPS_StatusReport_web.pdf.

Infoway gets cash injection
The federal budget announced on February 27 included a $500 million cash injection for Canada’s effort to implement electronic health records (EHR) across the country. The money was earmarked for Canada Health Infoway, an independent, not-for-profit organization established by the federal government to work toward the ultimate goal of providing every Canadian with an EHR by 2016. The announcement brings the government’s total investment toward the national EHR system to $2.1 billion. Infoway says it is still $7.9 billion short of the total funding it needs to reach its overall objective. Richard Alvarez, president and CEO of Infoway, doesn’t expect the cash to flow until the new fiscal year starts in April, but he estimates the funds will create 7,500 jobs over the next two years. Alvarez says boosting EHR systems will have a lasting affect on pharmacies. "Not only will it make them more efficient, it will very much make them part and parcel of an integrated care team." Source: "Federal budget includes millions for e-health records," Brett Ruffell, posted at www.pharmacygateway.ca, Jan. 29, 2009.

Pharmacists expanding role across country
Pharmacists are taking on an expanded role in managing drug therapy in a growing number of provinces. In October 2008, New Brunswick pharmacists gained the authority to perform continued-care prescribing, to issue new prescriptions for pre-existing conditions in emergency situations and to alter scripts to accommodate special needs. Other Atlantic provinces have similar changes in the works. Beginning in January 2009, British Columbia pharmacists will have the authority to adapt certain existing scripts. Meanwhile, Ontario’s Health Professions Regulatory Advisory Council has recommended that pharmacists in the province take on a prescribing role. Source: "Patients embrace pharmacists’ new role," Alison DeLory; "HPRAC recommends expanded scope for pharmacists," Sonya Felix; and "Expanded scope puts pharmacy in spotlight," Stephanie Cunningham, Drugstore Canada, December/January 2009.

Drug claims data can serve plan sponsors well
Drug claims data is a highly versatile and valuable tool, but is profoundly underutilized by drug plan sponsors. Transactional-level drug claims data can offer detailed insight for plan sponsors looking to better manage their benefits costs. Practical and useful applications for this plan information include: drug plan performance reviews, population health analysis to target wellness strategies, the integration of drug and disability claims data to improve disability management, and the assessment of the financial impact of proposed plan design changes. Source: "Drug Claims Data: The Duct Tape of Group Benefits," Mike Sullivan, posted at www.benefitscanada.com, Dec. 29, 2008.

Focus on prevention to lower healthcare costs
During a period of economic uncertainty, employers can rein in benefit plan costs by ensuring a healthy, productive workforce. This can be achieved by focusing on measures designed to encourage healthy living and reduce the occurrence of preventable conditions. Employers should offer health education initiatives as part of a holistic approach to promoting recovery, wellness, engagement and work/life balance. Employees need to understand that healthy, productive workers are important to their organization, and that the employer will provide programs designed to achieve and maintain that state. Source: "Will 2009 Be the Year of Prevention?" Sandra Beech, posted at www.benefitscanada.com, Dec. 04, 2008.

Ontario adding six drugs to coverage
Those who receive drug coverage under Ontario Public Drug Programs now have access to six additional drugs used for treating diabetes, colorectal cancer, hypertension, rheumatoid arthritis and psoriasis. "Ontarians with diabetes will be able to better manage their disease and colorectal cancer patients will have new hope of a successful treatment," says Health and Long-term Care Minister David Caplan. The public plan now covers: Lantus (diabetes), Vectibix (colorectal cancer), Rasilez (hypertension), Orencia (rheumatoid arthritis), and Enbrel and Raptiva (psoriasis). Source: "Briefly: ‘Ontario Improves Access to Drugs’", news brief posted at www.benefitscanada.com, Dec. 03, 2008.

Nova Scotia makes gains in workplace health
A three-year comprehensive workplace wellness study completed in Nova Scotia shows improved heath for employees, a reduction in the average number of lifestyle risk factors, and an overall boost in staff morale after the introduction of a program that includes health risk assessments and cholesterol and blood pressure screening. The Healthy LifeWorks project followed 400 employees from Nova Scotia’s Department of Justice and found that wellness scores improved by 12% over the course of the study. Significant improvements were noted in nutrition scores (up 19%), fitness (up 7%) and lifestyle risk factors (down 9%). Source: "Nova Scotia leads the way in workplace health," Andrea Davis, Employee Benefit News Canada, posted at http://ebnc.benefitnews.com, Dec. 02, 2008.

Generic drug makers dispute Fraser Institute study
A report prepared for the Canadian Generic Pharmaceutical Association (CGPA) disputes claims made in a recent Fraser Institute report called Canada’s Drug Price Paradox 2008. Professor Joseph D’Cruz of the Rotman School of Management, University of Toronto, led the research team for the CGPA report, which states that the Fraser report’s assertion that prices of generic prescription drugs in Canada are twice as high as in the U.S. "is a misleading conclusion based on faulty methodology." The CGPA report also claims that there is a striking similarity between positions taken by Canada’s Research-based Pharmaceutical Companies (Rx&D), the association representing Canada’s brand-name pharmaceutical corporations, and the Fraser Institute. CGPA’s Response to the Institute’s Report - Canada’s Drug Price Paradox 2008 is available for download at www.canadiangenerics.ca/en/news/dec_1_08.asp.

MedsCheck expands again
In early 2009, a pilot project focusing on collaboration between pharmacists, physicians and nurse practitioners (NP) will evaluate the next phase of the Ontario Public Drug Programs’ MedsCheck program. The idea behind MedsCheck Consult is to promote healthier patient outcomes and improve and optimize drug therapy. A MedsCheck Consult will be triggered by a pharmacist who identifies a drug-related problem during a MedsCheck, by a prescriber (physician or NP) who wants the pharmacist to provide recommendations and options to resolve a particular problem, or by a patient who identifies a problem. The trial will run for three months in at least 30 pharmacies across the province. Source: "Pilot phase of MedsCheck Consult coming" Sonya Felix, posted at www.pharmacygateway.ca, Nov. 27, 2008.

Generic usage could save millions, says Competition Bureau
A new federal report from Canada’s Competition Bureau suggests that major changes to the way drug plans and consumers obtain and pay for prescriptions are needed to realize $800 million in potential savings through increased use of generic drugs. Although some solutions put forward in the report—entitled Benefiting from Generic Drug Competition in Canada: The Way Forward—are already in the works, others are more controversial. The report’s authors urge employers to develop preferred provider networks, encourage the use of mail-order pharmacies and persuade patients to seek out lower prices. Source: "Competition Bureau supports major drug plan changes," Vicki Wood, posted at www.pharmacygateway.ca, Nov. 26, 2008.

Canada’s healthcare spending continues to rise
The Canadian Institute for Health Information’s (CIHI) National Health Expenditure Trends report says health spending in 2008 climbed $10.3 billion over estimated expenditures for 2007, an increase of 6.4%. Glenda Yeates, president and CEO of CIHI says healthcare spending is expected to continue to grow faster than Canada’s economy, outpacing inflation and population growth. Hospitals are still the largest component of healthcare spending, while drugs comprise the second largest expenditure. Spending on drugs—both prescribed and non-prescribed—is expected to account for 17.4% of healthcare spending in 2008, up from 15% a decade ago and 8.8% in 1975. Source: "Healthcare Spending to Reach $5,170 per Canadian in 2008" news brief posted at www.benefitscanada.com, Nov. 13, 2008.

More evidence linking workforce health improvement
The Centre for Health Value Innovation has introduced a new value-based tool, the Health Value Index (HVI), to demonstrate how health investments drive real change and flatten the healthcare cost curve. The Centre expects the tool to provide further evidence that by identifying risk early and supporting behavioural changes through a value-based suite of services, employers and payers can drive early and sustainable cost reductions and better use of resources. The HVI can be found at http://vbhealth.org/ahc/ahchviqsurvey-start.html.

Aggressive drug plan management moving into Canada?
The Canadian PBM industry is showing signs of willingness to adopt a U.S.-style approach to aggressively manage drug plan costs through rebating and formulary delisting. In the U.S., drug plans actively managed by PBMs generate average cost reductions of approximately 29%, compared to plans with no PBM support. Canadian plan sponsors can take advantage of the U.S. experience if they are willing and able to demand both transparency and an acceptable share of any resultant savings. The first step is to better understand the drivers of cost trends and the PBM business model. The second step requires an alignment of PBM and other industry stakeholders’ incentives with plan sponsor objectives. Source: "Through the looking glass," Allan Smofsky and Karen Millard, Employee Benefit News Canada, September 2008, pp 18 - 20.

Healthy behaviours and adherence can reduce costs
Employers are making greater efforts to promote patient adherence and foster a culture of health in the workplace to help manage chronic conditions. This year’s Solutions in Drug Plan Management Conference presented several examples of successful employee-initiated programs, including the use of financial incentives at U.S.-based Pitney Bowes and a smoking cessation program at General Motors in Canada. Employers need to create a "culture of health," said David Hom, chair of the Centre for Health Value Innovation in Fairfield, CT. "You want to target a disease, target a population, target the intervention and target the metric." Source: "Joining the Health Culture Club," Brooke Smith, Benefits Canada, August 2008, pp 51 - 57.

The ROI of partnering with healthcare providers
Ensuring that employees take their medications properly is a major challenge for drug plan sponsors since poor adherence means poorer health, greater absenteeism and lower productivity. Attendees at this year’s Solutions in Drug Plan Management conference heard from a roster of experts who discussed strategies for boosting plan members’ adherence to treatments and managing chronic disease in the workplace. A recurring suggestion was to partner with pharmacists and other healthcare providers. This was successfully done at GM Canada, which launched a smoking cessation program in partnership with Green Shield Canada and pharmacists trained in clinical tobacco intervention. Source: "Seeking Solutions, What’s the ROI in workplace disease management?" Sonya Felix, Pharmacy Post, August 2008, pp 10 - 13.

Convoluted rules for OTC coverage
New draft legislative proposals that clarify the eligibility of medications for the medical expense tax credit (METC) considerably complicates matters for employers with private health services plans that cover over-the-counter drugs. Released on July 14, 2008, the draft proposals offer a three-part test to determine if a drug, medicament or other product or substance be considered "prescribed" for METC purposes. Under the new rules, Schedule I and II drugs are METC eligible, but Schedule III is not. This causes problems for plan sponsors with members in multiple provinces, however, because of lack of consistency across Canada regarding which OTCs are behind the counter in pharmacies. Source: "Muddying the Waters for Employer Drug Plans," Karen DeBortoli and François Poirier, posted at www.benefitscanada.com, August 22, 2008.

Prevention the best medicine for cost control
Taming the Management Beast: Driving Costs Down and Satisfaction Up, a report from the Aberdeen Group, states that reducing medical insurance coverage isn’t the solution to rising health benefits costs. Rather, the answer is to find ways to make it less needed. Wellness programs and disease management can help rein in the need and cost of healthcare, but there are obstacles to managing an effective benefits program. Budget is a top challenge for 72% of organizations, 18% cite lack of automation of benefits data collection and management and 15% cite lack of visibility into the overall benefits program. Organizations that clearly communicate the benefits program to employees, routinely survey employees for satisfaction with the program and regularly measure the plan’s overall effectiveness make the greatest gains. Source: "Taming Benefits Costs", Craig Sebastiano, posted at www.benefitscanada.com, August 19, 2008

Educate employees to take charge of health
The top three strategic initiatives employers are using for long-term prescription drug cost management are providing employees with tools and information, educational programs, and worksite health and wellness activities, according to a Buck Consultants report, Understanding Your Strategies for Coping with the Changing Pharmacy Benefit Landscape. Employee involvement is key to long-term cost control, says Michael Jacobs, a principal at the consulting firm. He suggests that incentives such as cash and health coaching by an on-site nurse or pharmacist can help result in healthier employees and lower costs. Source: "Employee Involvement Key to Benefits Cost Control", Jody White, posted at www.benefitscanada.com, August 15, 2008.

Government ahead of private sector in managing drug plan benefits
The Ontario government’s new Competitive Agreements (CA) initiative, announced in early July, is intended to help the provincial government decrease the amount it pays for generic drugs. The process involves the government naming two winning bidders for each product it places on the CA list — starting with enalapril (for hypertension), metformin (diabetes), ranitidine (ulcer) and gabapentin (epilepsy, neuropathic pain). Although the formulary price of these drugs will remain at 50% of the brand cost, winning suppliers will provide quarterly cash rebates directly to the provincial government. It is conceivable that the unit price of CA drugs in Ontario could be more than double the cost for private plan sponsors than for the government. Source: "Private Plan Sponsors are Losing the Race," Mike Sullivan, posted at www.benefitscanada.com on July 30, 2008.

Solutions conference zeros in on CDM
Can and should employers play a role in chronic disease management (CDM)? If so, what’s the best way to do it and is the return worth the investment of time and money? Those are some of the questions discussed at this year’s Solutions in Drug Plan Management conference hosted by Pharmacy Post, Benefits Canada and Working Well in Toronto in early June. The invitation-only audience, made up of about 140 pharmacists, plan sponsors, insurers, pharmacy benefit managers, benefits consultants, pharmaceutical manufacturers and union representatives, heard from a roster of experts who addressed the theme: "The ROI of Chronic Disease Management in the Workplace." For in-depth coverage of the conference, please see the August issue of Pharmacy Post and September issue of Working Well.

What value-based design means to you
A tidal wave of people with chronic disease is coming, David Hom, chairman of the board for the U.S.-based Centre for Health Value Innovation, told attendees at the 2008 Solutions in Drug Plan Management conference. As the keynote speaker, Hom pointed out the reasons why employers need to develop strategies for managing chronic disease in the workplace. Although it makes sense that "an ounce of prevention is worth a pound of healthcare," he noted that 50% of the population already has a chronic condition. Ensuring compliance with treatment is a major challenge since poor adherence means poorer health, greater absenteeism and lower productivity. He went on to explain the value-based design strategy, a health management process, developed at Pitney Bowes, that uses claims data to invest in incentives to change behaviours and boost adherence to reduce financial and health risks. To find out more about value-based design and to read case studies of organizations using the strategy, go to www.vbhealth.org.

Useful tools to help change patients’ behaviour
A recently published book, written specifically for healthcare professionals, offers practical strategies for helping patients make choices to improve their health, from weight loss and exercise to smoking cessation and medication adherence. Motivational Interviewing in Health Care: Helping Patients Change Behavior, written by Stephen Rollnick, William R. Miller and Christopher C. Butler, was published in November 2007 by Guilford Press. Reviews, table of contents and sample chapters can be viewed at www.guilford.com, where the book may also be ordered.

How employers can prepare for future costs
The lack of new blockbuster drugs and recent availability of generics for many expensive brand name drugs has helped dampen the cost trend for plan sponsors in 2007 and 2008. This has helped to offset prescription drug utilization increases among the aging population. However, plan sponsors with wide-open plan designs that do not differentiate coverage based on cost-effectiveness will continue to be subjected to rising costs. Plan sponsors must measure and understand exactly what is driving their own unique claims experience and assess the impact of alternative plan designs for which cost-effectiveness and value are the driving principles. Source: "New drugs in town," Chris von Heymann, BenefitsCanada, June 2008, pp 33 - 37.

Encouraging consumerism in healthcare
Prescription drugs have changed, spending has changed and employer-sponsored drug benefits plans must change to remain sustainable. Total prescription drug spending in Canada increased by more than 600% over the last 22 years. Cost drivers include greater utilization, higher ingredient costs and cost-shifting from public to private payers. Consumerism programs based on sharing costs with employees and equipping them with information and tools to help them understand drug treatments and costs are the long-term solution to managing escalating drug plan costs. Source: "Buyer beware," Barbara Martinez, Benefits Canada, June 2008, pp 38 - 43.

Employees want help to manage their health
Engaging employees to adopt new behaviours and healthy lifestyles is emerging as a longer-term strategy to control costs and improve employee health and productivity. In this year’s sanofi-aventis Healthcare Survey, 96% of respondents believe that preventing disease, illness and injury would help control the costs of health benefits plans and 96% are comfortable with their employers helping them to manage their health. But education alone isn’t enough to produce change. Employees also need tools and information to make better choices and employers need to make it easier for employees to do the right thing. And it has to be personal. Source: "An Important Engagement," Wendy Bott, Benefits Canada, June 2008, p. 61.

CDR boosts transparency
First formed in 2003 to provide drug formulary recommendations to federal, territorial and provincial (except Quebec) drug plans, the Common Drug Review (CDR) is becoming more open and transparent. This follows a federal investigation of CDR processes last year in response to pressure from lobby groups, which criticized the CDR as a major barrier to access to new treatments. Now healthcare professionals and patients can get more information about clinical trials and CDR recommendations by going to http://cadth.ca/index.php/en/cdr/search. Source: "Common Drug Review a work in progress," Celia Milne, Pharmacy Post, June 2008, pp 1 & 11.

Employers shifting focus to workplace health and wellness
Forward-thinking employers and benefits payers are shifting their perspective from managing the costs of disease to making an investment in workforce health and wellness. There is growing interest in value-based health care design, which uses data to identify risk and introduce incentives to change behaviours. Key to rollout of a value-based design is the utilization of data to build the business case. The first level of the design identifies waste and emerging risk in order to develop strategies to remove access and cost barriers to achieve early improvement in the management of chronic conditions. The second level is the lifestyle management incentive that supports personal health optimization. Source: "Value-based design meets employer expectations for health improvements, cost savings," Cindy Nayer, Employee Benefit Plan Review, July 2008, pp 8 - 10. (Also available at www.vbhealth.org)

Catastrophic illnesses not driving drug spending
Specialty drugs and catastrophic conditions aren't typically to blame for rising drug costs. The average Canadian plan sponsor in 2007 spent about 10% of its prescription drug budget on specialty drugs. Although spending 10% of a drug plan budget on a fraction of 1% of the total number of claims is without question a financial burden, by better managing the 90% spent on treating high blood pressure, diabetes, asthma, depression and other common conditions, there would be far less year-over-year cost inflation, and more resources available for plan sponsors to fund therapies for catastrophic conditions not covered by the public purse. Source: "The Myths of High Users within the Prescription Drug Plan," Mike Sullivan, posted at www.benefitscanada.com on May 26, 2008.

Canadian company wins adherence awards
Rx Canada has won a Strategic Patient Adherence (SPA) Award for its pharmacy-based programs that help patients take their drugs properly. More than 3,000 pharmacies in Canada have access to Rx Canada’s Health Inform and Professional Pharmacy Consultation programs, which delivers print or electronic educational pieces to patients over a period of time to help remind them to take their medication. Patients enroll in the program in the pharmacy, at no cost to them. Rx Canada works with pharmaceutical manufacturers or other funding sponsors to provide chronic disease management programs for a number of health conditions, including asthma, high cholesterol and Alzheimer’s disease. Independent research shows that people enrolled in Health Inform are significantly more likely to be renewing their medication one year later than those who are not enrolled. Rx Canada is the first winner outside the U.S. to win a SPA award. Source: "Canadian firm wins U.S. awards for helping patients take their medicines correctly," Rx Canada press release, May 16, 2008.

Drug spending continues to rise
National drug spending rose 7.1% last year and will continue to rise, according to John Herbert, director of business development at ESI Canada. On average, drug spending increased $44 per claimant to $665 last year; spending is lowest in the Western Canada and highest in Ontario. Among reasons for the rising cost of claims, Herbert pointed to a combination of claim intensity and increasing costs per script due to inflation and therapeutic mix of drugs. He identified several tools plan sponsors can use to lower drug costs, including coordination of benefits, member payment, generic substitution, managed formulary and prior authorization. Source: "Increase in Drug Spending Expected to Continue," Jody White, Benefits Canada, posted at www.benefitscanada.com, April 23, 2008.

Studying the reasons for noncompliance
In the second phase of a study commissioned by the Global Business and Economic Roundtable on Addiction and Mental Health, Cubic Health Inc. is looking at employee compliance and noncompliance with prescription medications. During the first phase, the Toronto-based drug management company analyzed more than 2.5 million group insurance drug claims and found a significant correlation between depression and other chronic conditions prevalent in the workplace. The new study is expected out this summer and should provide key insights into why as many as 50% of patients are noncompliant. Source: "Company tackles reasons behind noncompliance," Sonya Felix, Pharmacy Post, April 2008, p.11.

Employees want to help control costs
The majority of plan members interviewed for this year’s sanofi-aventis Healthcare Survey say they are willing to help plan sponsors control expenditures. Growing numbers are interested in a user-pay approach, in lower costs for those with good personal health practices and in more flexibility with plan choices. At the same time, 96% believe preventing disease, illness and injury would help control the costs of health benefit plans and 94% say educating employees on these matters would help keep them healthy and productive. Source: "The sanofi-aventis Healthcare Survey 2008," available as a pdf download at www.sanofi-aventis.ca

Employers need to address presenteeism
The cost of drugs and absenteeism are only the tip of the iceberg. The most obvious direct costs of poor employee health are higher medical and pharmacy bills. However, the high incidence of relatively minor conditions such as migraine headaches, allergies and asthma, arthritis, irritable bowel syndrome and menstrual issues can have an impact on productivity. Immediate cost-containment and ROI to plan sponsors can be achieved through a corporate wellness program that focuses on the hidden issues driving presenteeism. Source: "Get the biggest bang for your wellness bucks," Jeffrey Brock, Employee Benefit News Canada, March/April 2008, p. 18.

Pharmacist intervention helps save dollars and risk
Quantifi, a clinical documentation software program from U.S.-based Pharmacy OneSource, Inc., allows pharmacists to document their clinical interventions, adverse events and adverse drug reactions over the internet or on a handheld computer. Currently used by hundreds of hospitals around the world, Quantifi users documented increases in pharmacist interventions with accompanying dollar and risk avoidance savings. A free report, Pharmacy Clinical Interventions Update, with the top 10 drugs associated with interventions, adverse drug events and medication errors is available by submitting contact information at http://vovici.com/wsb.dll/s/ed15g2aaea.

Boost motivation to promote adherence
Pharmacists are perfectly positioned to motivate and educate patients to improve adherence to drug therapy, says Grant Corbett, researcher and principal of Behaviour Change Solutions in St. Catharines, Ont. Speaking at the Rx Connect Symposium hosted by Rx Canada, he urged pharmaceutical manufacturers to work directly with frontline pharmacists and physicians to develop adherence programs that motivate patients to take ownership of their treatment. Corbett also noted that Rx Canada’s Health Inform program is a good example of an adherence tool for pharmacists to use with patients. Source: “Make adherence a goal, not a duty,” Karen Welds, Pharmacy Post, March 2008, p.25.

Covering lifestyle drugs a smart strategy
Medications for treating obesity, infertility, erectile dysfunction, male pattern baldness and smoking cessation are often viewed as a low priority by drug plan sponsors. But there may be a good business case for covering so-called “lifestyle” drugs. Organizations that demonstrate a dedication to maintaining a healthy workplace and have the best interests of employees at heart may have the upper hand in the ongoing competition for talent. And helping employees to deal with obesity or smoking can potentially avoid other serious health conditions in the future. Source: “Lifestyle Choices,” Sarah Beech, Benefits Canada, March 2008, p. 45.

Heart health program promotes lifestyle changes
Brake for Health, an on-site cardiovascular screening program set up in partnership between Shoppers Drug Mart and the Canadian Auto Workers (CAW), is successfully getting employees to make lifestyle changes to manage hypertension, high cholesterol and elevated glucose readings. Based on results from last year, 42% of “at risk” workers at General Motors in Oshawa, Ont. and 32% of similarly identified workers at GM’s Woodstock, Ont. plant have made changes such as an improved diet, exercise, stopping smoking and self-monitoring cholesterol and blood pressure. Source: “Workplace wellness picks up speed,” Pharmacy Post, Feb. 2008, pp.14, 15.

Non-adherence causes heart deaths
Not filling prescriptions after a heart attack can significantly increase the risk of dying in the first year after leaving the hospital, says a new study from Ontario’s Institute for Clinical Evaluative Sciences (ICES). Researchers analyzed data from 4,591 heart attack patients in Canada and the 12,832 prescriptions written as a result of the heart attacks. The results showed that one in five scripts was not filled. Patients who filled none of the prescriptions had an 80% higher chance of dying in the year following the attacks versus those who filled all their prescriptions. Source: “More Heart Deaths?” Media release posted at www.ices.on/ca/webpage.cfm on Feb. 26, 2008.

Depression linked to high Rx costs
Employees being treated for depression cost their employers more than 2.5 times as much for prescription medications as employees without depression and have nearly three times as many prescriptions per year, according to a recent study of drug claims data by Cubic Health Inc. for the Global Business and Economic Roundtable on Addiction and Mental Health. One of the study’s major findings is the link between depression and other chronic conditions such as anxiety disorders, sleep disorders, stomach hyperactivity, elevated cholesterol, hypertension, inflammatory conditions and asthma. Source: “Hard Dollars of Depression,” Chris von Heymann, Benefits Canada, Feb. 2008, p. 65.

Increased prescribing for Alberta pharmacists
Pharmacists in Alberta can now apply to their regulatory body to obtain additional authorization to prescribe for initial access or to manage ongoing therapy. Pharmacists will be able to initiate prescription therapy or adjust ongoing therapy, without prior approval from the person’s physician. Direct patient consent and detailed documentation to the physician are required, and only pharmacists with an established expertise in chronic disease management—in areas such as asthma, hypertension, dyslipidemia and diabetes—are expected to pass the rigorous application process.

In B.C., meanwhile, retail pharmacists should be able to independently adapt existing prescriptions (e.g., write prescription refills) come March. Regulators there are careful to describe the activity as "medication management," however, not prescribing, as this level of authorization—which is already available to hospital pharmacists—does not include prescribing for initial access or to manage ongoing therapy, as is the case in Alberta.
Source: "Alberta takes next major step," Karen Welds, Pharmacy Practice, February 2007, pp 22-23

EHR a reality in Sault Ste. Marie
Pharmacists and physicians in Sault Ste. Marie are breaking new ground in integrated care with EMRxtra, an important pilot project for the electronic health record (EHR) in Canada. Partially funded by Canada Health Infoway, the agency mandated by federal and provincial governments to make the EHR a reality, EMRxtra has successfully connected primary care physicians with community pharmacists, giving the latter electronic access to lab test results, allergies and other medical data from consenting patients' electronic medical records. This is expected to reduce the number of adverse medical events and improve drug therapy management for patients with chronic conditions.
Source: "Pharmacists and Physicians Exchanging Medical Data Stored In Patients' Electronic Medical Records," Canada Health Infoway news release, January 23, 2008.

Deeper analysis required for drug claims data
Over the next few years, more than half of all new drug approvals will likely be for expensive specialty drugs. Yet few drug plan sponsors in Canada are using plan-specific drug claims data to implement targeted, meaningful solutions to deal with rising prescription drug costs. Before making changes to their plans, employers and their consultants need to give due diligence and proper consideration to budget limitations, plan member health, and issues related to a specific disease state and demographic profiles.
Source: "Drug Plans in 2008 and Beyond," Mike Sullivan, Benefits Canada online news (www.benefitscanada.com), posted January 9, 2008.

Prepare for higher cancer costs
With the rising number of newly diagnosed cancer patients and new cancer drugs, along with limited provincial funding for health care, third-party payers and plan sponsors should be prepared for the increased costs of covering cancer drugs. The most effective cost-control measure is to ensure that the appropriate drug is covered for the appropriate medical condition under the right circumstances. Plan sponsors must also understand access and availability of different cancer treatments and should inform members about cancer prevention strategies.
Source: Source: "Cancer costs," Priscilla Po, Benefits Canada, December 2007, pp 55-59

Specialty drugs demand integrated care
Specialty drug utilization is outpacing the year-over-year cost increases of traditional drugs and that’s of great concern to employers. As volume demands and the costs of novel drug therapies rise, plan sponsors need to develop and implement an integrated care model that focuses on the necessary infrastructure—including delivery, administration, compliance and monitoring—to ensure that ongoing investment in drug benefits is well spent. An effective pharmacy care model must evolve beyond the "dispensing event" to a progressive focus on the full continuum of care.
Source: "Model Care," Shawn O’Brien, Benefits Canada, November 2007, pp 65-67

Pharmacist prescribing now in New Brunswick
Amendments to the Pharmacy Act in New Brunswick now allow pharmacists to replace, extend and renew some existing prescriptions, issue a new prescription for pre-existing medical conditions in an emergency situation and alter prescriptions to accommodate special needs. This expanded role for pharmacists means that New Brunswickers may not have to make unnecessary trips to the emergency room or after-hours clinic for their prescription medications. Dennis Abud, president of the New Brunswick Pharmacists’ Association, stresses that pharmacists won’t be diagnosing illnesses and there are regulations in place to ensure that physicians are notified if a pharmacist renews or extends a prescription. Source: "New Brunswick pharmacists win prescribing authority," Chris Reynolds, posted at www.pharmacygateway.ca/news October 30, 2008.

Fraud costs billions each year
Insurers, plan sponsors and members lose between $1 billion and $5 billion each year to fraud, according to the Canadian Health Care Anti-fraud Association. This staggering sum is passed on to employers and plan members in the form of higher benefits premiums. “Doctor shopping” (obtaining prescriptions from more than one physician) and misrepresentation of dependents are among the most common types of fraud. Plan sponsors are advised to work with benefits administrators to detect fraud and to educate employees about the magnitude and cost of benefits fraud. Source: “Fraud Squad,” Sean Maxwell, Benefits Canada, Oct. 2008, pp. 25, 27.

Move to plan-sponsor centric drug plans?
Pricing discrepancies between public and private sector drug plans are driving plan sponsors to take a more active role in managing their investments in this area. While price controls and rebates on generic drugs appear to help manage costs on the public side, private payers typically pay more for the same products off the same shelf at any given pharmacy. Pricing discrepancies within the private sector and excessive mark-ups on actual acquisition costs add to the need for change. Source: “Drug Discrepancies in Canada,” Mike Sullivan, posted at www.benefitscanada.com, Oct. 15, 2008.

Program reduces benzo use
An innovative program to monitor and improve the use of benzodiazepines in Saskachewan has reduced the use of these prescription drugs by 60% between 2005 and 2007, according to Doug Spitzig, consulting pharmacist with the Prescription Review Program and the College of Physicians and Surgeons of Saskatchewan. Commonly known as “benzos,” benzodiazepines are used to treat anxiety, insomnia, agitation, seizures, muscle spasms and alcohol withdrawal. However, the drugs can cause side effects and drug dependence if used inappropriately. The province-wide program monitors prescribing and educates physicians on appropriate practice. Source: “SK Program Monitors Benzo Use,” Marie Powell Mendenhall, Drugstore Canada, Oct. 2008, p. 10.

Upfront costs can result in long-term savings
Innovative pharmaceuticals can improve outcomes and reduce health costs in the long run—including drug costs, Wendy Zatylyn, vice-president stakeholders and partnerships with Rx&D, told the audience at this year’s 2008 Drug Innovations Forum hosted by Working Well magazine. Plan sponsors attending this third annual conference got a glimpse of what’s new on the drug and therapies landscape and listened to industry experts discuss why new or alternative treatments should be included under public and private healthcare plans. Source: “Short-term Pain for Long-Term Gain,” April Scott-Clarke, posted at www.benefitscanada.com, Sept. 22, 2008.

Drug cost burden slightly higher in Canada
While brand-name drugs are about 53% less expensive in Canada than in the U.S., generic drugs are on average about 112% more expensive here than south of the border. Lower wages in Canada is one reason why, says a new report from the Fraser Institute. Canadian government policies also shield retail pharmacies and generic drug manufacturers from competitive market forces that would put downward pressure on generic drug prices The report concludes that the Canadian government’s involvement in prescription drug markets offers no cost advantages for consumers compared to the impact of relatively more free-market policies found in the U.S. Source: “Cost Burden of Prescription Drug Spending in Canada and the United States, 2008 edition,” Brett Skinner and Mark Rovere, Fraser Alert posted at www.fraserinstitute.org, Sept. 2008.

Public-sector scheme could raise costs for private payers
Ontario’s Competitive Agreements for generic drugs came into effect Oct. 1 as a plan to lower the cost of generic drugs for the Ontario drug benefit plan. Although the government maintains that similar schemes in New Zealand and the U.S. have resulted in savings of up to 81% for public plans, the new policy could cause drug companies to look to private plans to make up lost revenue. “Eventually, people [private payers] are going to get smart and wonder why they’re paying twice the cost, or more, for drugs than the public sector,” says Mike Sullivan, president, Cubic Health. Source: “Front Lines: the Drug Divide,” Jody White, posted at www.benefitscanada.com, Sept. 1, 2008.

Poor lifestyle choices the real culprit
Annual prescription drug spending surpasses $20 billion in Canada, yet no one seems to have the answer on how to effectively manage this aspect of our healthcare system. So who is the villain in this story? The list of potential suspects includes brand name pharmaceutical manufacturers, generic pharmaceutical manufacturers, healthcare professionals (physicians and pharmacists), plan sponsors and governments. But perhaps the biggest and most overlooked villain in the scenario is a Canadian population that has an expanding list of ailments resulting from poor lifestyle choices. Source: “The Great Drug Debate: Who is the Villain?” Brian Lindenberg, posted at www.benefitscanada.com, Sept 3, 2008.

Albertans awaiting details on new pharmaceutical strategy
Some time this fall, Alberta’s provincial government is expected to release details of an Alberta Pharmaceutical Strategy focussed on four priority areas: access, fair and reasonable prices, appropriateness and governance. In 2007, the province allocated $4.5 million to the initiative and in April 2008 reconfirmed that it would implement a new pharmaceutical strategy to address the cost of pharmaceuticals and support the effective use of drugs. At that time, the government promised to provide further details within six months. Source: “Alberta pharmacists await new pharma strategy,” Barbara Kermode-Scott, Drugstore Canada, Sept. 2008, p. 11.

Pharmacists can help improve adherence
Promoting MedsCheck in the workplace is in the best interest of employers, Rosemarie Patodia, pharmacist and manager, pharmacy marketing and professional services, Shoppers Drug Mart, told the audience at this year’s Solutions in Drug Plan Management Conference. Launched in Ontario last year, the government’s medication review program pays pharmacists to provide extended counselling to people taking three or more medications. Patients learn what the medication is for, how it works, how to take it properly and what to expect in outcomes. A follow-up review is also available. "Optimizing medication use can prevent devastating events that can have significant [health and financial] costs associated with them," Patodia said. Source: "Over-The-Counter Advice," April-Scott Clarke, Benefits Canada, August 2008, p. 53.

EHR a reality in Sault Ste. Marie
Pharmacists and physicians in Sault Ste. Marie are breaking new ground in integrated care with EMRxtra, an important pilot project for the electronic health record (EHR) in Canada. Partially funded by Canada Health Infoway, the agency mandated by federal and provincial governments to make the EHR a reality, EMRxtra has successfully connected primary care physicians with community pharmacists, giving the latter electronic access to lab test results, allergies and other medical data from consenting patients' electronic medical records. This is expected to reduce the number of adverse medical events and improve drug therapy management for patients with chronic conditions.
Source: "Pharmacists and Physicians Exchanging Medical Data Stored In Patients' Electronic Medical Records," Canada Health Infoway news release, January 23, 2008.

Asheville project shows value of pharmacy
For the past decade, pharmacists have helped manage chronic conditions for employers in Asheville, N.C. The Asheville Project now has data proving positive results in cost management as well. Participating employers’ overall health costs declined by more than $6 million in eight years—even though they were spending more for medications and paid pharmacists for their services. Employee sick days declined 50% for diabetes patients and a whopping 400% for people with asthma. Source: “Everybody wins in collaborative-care model,” Tanya Stuart, Pharmacy Post, September 2006, p.7.

Teamwork needed to manage drug plan costs
Drug plan sponsors, healthcare industry stakeholders and government need to work together to take control of rising drug plan costs. That’s one message that came out of this year’s Solutions in Drug Plan Management conference. Attendees also discussed the importance of getting employees to take charge of their own health and the need for adherence to medication. “A lot depends on how engaged the employer is in their benefits and the health of their employees,” said Jeff May, vice-president, pharmacy, professional affairs, Shoppers Drug Mart.
Source: “Solutions & Synergy,” Leigh Doyle, Benefits Canada, August 2006, pp. 30 - 32.

Plan members happy with benefits plans
Most employees would rather have a health benefits plan than receive $15,000 in cash every year, according to the 2006 sanofi-aventis Healthcare Survey, which also showed the highest level of employee satisfaction since 2002. The availability of more choice in benefits plan design and coverage levels, convenient drug cards and online dental claim submissions have improved service and lowered cost increases, which in turn likely contributed to increased employee satisfaction.
Source: “Plan members know they have a good thing,” Canadian Healthcare Manager, August 2006, p. 9.

Savings weighed from prior authorization
A recent study by ESI Canada showed that prior authorizations (PAs) effectively reduce drug plan expenditures. The study measured the impact of PAs on four therapeutic classes—rheumatoid arthritis (RA) biologics, osteoarthritis drugs, erectile dysfunction drugs and anti-obesity agents. About 20% of PA prescriptions for osteoarthritis and erectile dysfunction drugs were eventually reimbursed for the original prescription, while 30% of claims for PA anti-obesity agents were reimbursed and 74% of RA biologics claims were reimbursed. The study did not measure the clinical implications of patients not having a claim for either a PA or a substitute non-PA drug. Source: “Access Denied,” Cory Cowan, Benefits Canada, September 2006, pp. 26 - 29.

Asthma not well-controlled
Although most (97%) Canadian adults with asthma believe their asthma is well-controlled, it’s true for only 47% of them according to The Reality of Asthma Control (TRAC) study. Only 11% of patients had a written asthma management action plan and only one half of these patients followed the plan regularly. Almost three out of four asthmatics were concerned about using inhaled corticosteroids. And only 39% of physicians based their treatment recommendations on the Canadian asthma guidelines. Source: “Asthma control in Canada remains suboptimal: The Reality of Asthma Control (TRAC) study”, JM Fitzgerald, LP Boulet, RA McIvor, Can Respir J, 2006, pp. 253-9.

Information needed to manage benefits wisely
Plan sponsors and their consultants must get serious about long-term strategies in adherence and disease management, said Marc Kealey, CEO of the Ontario Pharmacists’ Association, speaking at the 2006 Solutions in Drug Plan Management conference. Other speakers re-emphasized the point during panel discussions about the success of various adherence programs focusing on asthma, diabetes, hypertension and high cholesterol. Most participants agreed on the need for education and communication on all sides: access to data can show employers which disease-management programs would have the biggest impact and employees need to know about their drug plan to understand its value. Source: “Searching for drug plan solutions,” Tanya Stuart, Pharmacy Post, August 2006, pp. 23, 25.

Healthy employees good for business
Senior executives at Envision Financial in Langley, B.C., recently approved a five-point program linking employee well-being to the company’s overall business strategy. The plan includes developing awareness of wellness at all levels of the organization, improving organizational health by reducing employee health risk and encouraging participation in well-being initiatives, and measuring the level of coordination and integration between strategy and well-being. The company expects the program will also assist with recruitment and retention. Source “Employee wellness is their business strategy,” Alison MacAlpine, Canadian Healthcare Manager, August 2006, p. 11.

Bill 130 addresses cost containment
The impact of Quebec’s new pharmaceutical policy, tabled as Bill 130 in 2004 and passed at the end of 2005, is expected to be felt primarily by people covered under the Régie de l’assurance maladie du Québec (RAMQ). The new Bill’s cost containment provisions will likely have a limited impact on private plans. However, an amendment of the Hospital Insurance Act, which could require newer and more expensive drugs to be purchased in community pharmacies, might transfer costs to private plans. Source: “Mixed Blessing,” Alain Robillard, Benefits Canada, June 2006

Ontario revises Bill 102
After a series of public hearings in early June, Ontario’s Ministry of Health and Long-Term Care announced several changes to its proposed Transparent Drug System for Patients Act, or Bill 102, including: creating a Code of Conduct for pharmacists, allowing professional allowances of up to 20% of the value of public-sector generic drug sales; securing volume discount benefits on drugs purchased for the public system; entrenching the new Pharmacy Council and Citizen’s Council into the legislation; instituting automatic second reviews of decisions by the Committee to Evaluate Drugs or the Executive Officer to not list drugs; requiring the Executive Officer to prepare annual reports; adding a clause that specifically prohibits therapeutic substitution; and establishing a joint working group with industry and the Ministries of Health and Long-Term Care, Research and Innovation, Economic Development and Trade.
Source: “McGuinty government strengthens Drug Strategy,” press release, Ontario Ministry of Health and Long-Term Care, www.health.gov.on.ca, June 6, 2006.

Newfoundland and Labrador to get e-health record
The government of Newfoundland and Labrador plans to implement a provincial drug tracking system to improve medication dispensing and counselling, reduce medication errors and decrease hospitalization due to adverse drug events. Expected to be operational by early 2008, the Pharmacy Network will be under the auspices of Canada Health Infoway, the agency mandated to work with governments across Canada to implement an electronic health record. Source: “Emergis signs deal to provide Newfoundland and Labrador with drug info system,” Canadian Press, posted to CBC news website, June 8, 2006.

Employees want more choice in benefits
The sanofi-aventis Healthcare Survey 2006 reports that employees are accepting more personal responsibility for healthcare management. Only 39% of respondents rely on their doctor’s advice, seldom questioning it. Education programs on high blood pressure, heart disease, diabetes, asthma or obesity are a priority for 77%. Almost two-thirds (63%) believe coverage for cutting-edge drugs should be a priority for an employer. Source: “Healthcare consumerism,” Kim Laudrum, Benefits Canada online newsletter, posted June 2, 2006.

Pharmacists concerned about Bill 102
The Coalition of Ontario Pharmacy, a collective of chain and independent pharmacies, took to the streets to protest Ontario’s proposed Bill 102, claiming that, if passed in its original form, it would cost pharmacy $500 million and force hundreds to close their doors. The group lobbied for “a revenue-neutral guarantee for pharmacy,” says Rita Winn, general manager and COO of Lovell Drugs. Source: “... and the buzz around Bill 102,” Tanya Stuart, Pharmacy Post, June 2006, p. 1, 10.

Lessons from New Zealand
Three critics of New Zealand’s national drug system (Pharmac), including two practicing physicians, presented their views to a forum of Canadian physicians, pharmacists and patient advocates who met to discuss the potential implications of Canada’s planned National Pharmaceuticals Strategy. The bottom line, according to the New Zealanders, is that while Pharmac strategies slowed drug-cost increases, patient care, the morale of professionals and the health system overall have suffered. “The key result of Pharmac is that it severly restricts access to innovative drugs with a strong negative impact on health outcomes,” said Alex Sundakov, who has co-written a report called New Zealand Pharmaceutical Policies. He added that Pharmac appears “to produce poorer disease management and more interventions.” Source: “NZ lesson: patients pay for cost-focused drug strategy,” Vicki Wood, Pharmacy Post, June 2006, p. 11.

Why drug claims aren’t paid
Pay-direct drug cards offer advantages to both employees and employers. But there are also challenges, including a variety of reasons why drug claims are not paid as expected, or not paid at all. Some of those reasons include incorrect plan or certificate number, coverage termination, DIN/PIN not covered, identical claim has been processed, patient not found or date of birth error, professional fee cut back or ingredient cost reduced. If it isn’t possible to find a reason why the claim is rejected, plan members should be advised to contact his/her insurance carrier for more information. Source: “Rejected! Top reasons why pay direct claims aren’t paid,” Suzanne LePage, Pharmacy Post, June 2006, p. 13.

Saving through coordination of benefits
Private drug plans are often covering LU (limited use) or ME (Medicaments d’exception) benefits for members over age 65 because prescribers skip the additional paperwork required for provincial plans to cover the drug claim. As far as private plans are concerned, the primary submission of a claim for an LU or ME drug implies that the patient does not meet the criteria for provincial drug plan coverage, and so the private plan covers the claim according to plan description. As a result, private plans may be covering LU or ME drug claims in full when they should have been coordinated with the public plan first. This issue has already contributed to rising costs for private plans with coverage for retiree groups. With an increasing number of Canadians turning 65 in upcoming years, its potential impact will only get worse. Source: “Managing COB a plus for payers that costs pharmacists,” Chris von Heymann, Pharmacy Post, May 2006, p. 31.

Broader scope of practice for Alberta’s pharmacists
Alberta’s new Health Professions Act gives the province’s pharmacists a broader scope of practice, including the authority to prescribe certain drugs—a first in Canada. The new regulations allow pharmacists to prescribe some drug treatments, continue prescriptions initiated by other health practitioners and administer injection drug treatments such as vaccines. The change is expected to give patients better access to drugs. Source: “New regulations let pharmacists prescribe drugs,” Edmonton Journal, Wednesday, May 31, 2006.

Making ODB second payer will cost employers
Ontario’s plan to reform the provincial drug system is expected to have substantial impacts on employers with drug plans. The government’s recommendations include making the Ontario Drug Benefit Program (ODB) the second in-line payer for prescription drugs for working seniors with private insurance plans. With the end of mandatory retirement and costs shifting from government to employers who provide medical and drug coverage to workers over the age of 65, employers will likely have no choice but to provide coverage to older workers. Source: “Reforms to change Ontario’s drug program,” Leigh Doyle, Benefits Canada online newsletter, posted May 01, 2006.

If you bill it, insurance will come?
The Quebec Association of Pharmacy Owners is urging pharmacists to bill for their extra pharmacy services, and to encourage patients to submit copies of their invoices to insurers. While reimbursement can’t be guaranteed, its goal is to demonstrate the growing demand and support for pharmacists’ professional services outside of dispensing. Claude DiStasio at the Canadian Life and Health Insurance Association (CLHIA) agrees that “it’s supply and demand that applies” when it comes to reimbursing for services outside of standard agreements. Source: “Will insurers reimburse patients?” Allison Hay, Pharmacy Post, March, 2006.

Prescribing role for pharmacists
The Nova Scotia College of Pharmacists and the College of Physicians and Surgeons of Nova Scotia will soon take their first joint step toward expanding the scope of pharmacy practice. “Continued care prescriptions” will give pharmacists the authority to extend an existing prescription where an urgent need exists for refill but the prescribing physician is unavailable. Future initiatives under consideration include giving pharmacists authority to administer vaccinations and to monitor anticoagulation therapy. Source: “NS doctors and pharmacists sign expanded practice rules,” Peggy Amirault, Pharmacy Post, February, 2006, p. 3.

Preparing for the future
Despite an aging population, unhealthy lifestyle choices and the increasing costs of prescription drugs, industry experts at the third annual Face-to-Face Forum on Drug Plan Management insist that employers can take positive measures to ensure that their plans remain cost effective while providing the benefits that ensure a productive workforce. Source: “Canadian Drug Plans in a Global Context,” special supplement published in Benefits Canada, February, 2006.

Online database catalogues most drugs
With funding from Genome Alberta and Genome Canada, researchers at the University of Alberta have compiled an online catalogue that lists almost all known drugs and their corresponding destinations in the human body. The DrugBank website is accessible at http://redpoll.pharmacy.ualberta.ca/drugbank for researchers, healthcare professionals and the general public. Future plans include the addition of pricing information. Source: “U of A’s DrugBank gives doctors and information high,” Amanda Ash, The Gateway online, January 26, 2006, http://www.gateway.ualberta.ca/view.php?aid=5522

Prescription drug spending slows in U.S.
The U.S. growth rate for healthcare spending is dropping, according to a report from the Centre for Medicare and Medicaid Services. Health spending rose 7.9% in 2004 compared to 8.2% in 2003 and 9.1% in 2002. While hospital spending continues to rise, prescription drugs accounted for only 11% of the overall increase in 2004. Increases in personal spending also fell, from 23% between 1997 and 2000 to 14% between 2002 and 2004. The downward trend is attributed to the growth of generic drug options, more over-the-counter drug use and concerns over certain prescription drugs’ safety. Source: “U.S. Healthcare Spending Rate Slows: Medicare Report (United States)”, Terri Goveia, Canadian Healthcare Manager online news, posted January 19, 2006, http://www.chmonline.ca/ceonewsletter/jan19/article1.jsp

Employees need to know benefits costs
Most employees take benefits for granted and it is up to employers to educate their workers, Sharon Vanderwerff, consultant with Mercer Human Resource Consulting, said at the Canadian Institute’s 3rd Annual Employee Health Benefits Costs seminar. Year-round, personalized communication and a long-term approach are essential to helping employees understand the costs of benefits and how their behaviour affects those costs. Vanderwerff added that plan sponsors should focus on areas where they have an influence, such as employee behaviour, rather than demographics and costs of treatment. Source: “Plan sponsors should leverage communication,” Joel Kranc, Canadian Healthcare Manager online news, posted January 19, 2006, http://www.chmonline.ca/news/article.jsp?content=20060117_103538_5176.

Innovation needed to manage drug costs
Canadian plan sponsors need to do more to emulate their U.S. counterparts when it comes to managing drug benefit programs. Strategies such as multi-tier formularies, prior authorization, high amount pooling, maximum allowable cost, flex benefits, specialty pharmacies, health risk assessments and disease management programs are slow to be adopted by Canadian employers. A more aggressive, hands-on approach could help ensure sustainability and effectiveness of drug plans in Canada.
Source: “A bitter pill,” Shawn O’Brien, Benefits Canada, January 2006, pp. 18-19.

Plan sponsors should partner with pharmacists
As the last health care professional a patient sees before taking a drug, pharmacists play a big role in providing advice to drug plan members. But employers tend to “commoditize” pharmacists and dispensing fees, says Marc Kealey, CEO of the Ontario Pharmacists’ Association. Instead, plan sponsors could be partnering with pharmacists to develop and implement disease management programs. To get this message across, OPA’s latest pharmacist awareness campaign is aimed at third-party payers and insurers.
Source: “Dispensing advice,” Joel Kranc, Benefits Canada, January 2006, p. 9

B.C. slows drug plan costs
Despite B.C.’s universal drug plan and high proportion of aging retirees, drug costs in the province increase by less than 10% a year, according to the Canadian Institute for Health Information (CIHI). In 2002, B.C.’s drug plan covered 51% of all drug spending, versus the Canadian average of 37%. Yet drug expenditures per capita sits at about $486 in B.C. compared to $587 in Canada. B.C.’s lower numbers can be attributed to its restrictive formulary policies, including a reference-based drug program, a limited-use policy and a lowest cost alternative program.
Source: “B.C.’s drug policies keep cost increases lowest,” Ann Graham Walker, Pharmacy Post, November 2005, p 3.

Pharmacists drug experts in home care
The Saskatchewan Health Quality Council (HQC) has set up eight demonstration projects to test strategies for medication management and among seniors in special care homes. Community pharmacists conduct onsite medication reviews, document recommendations, follow up with patients and educate other team members. As well, pharmacists will lead the measurement and reporting of drug usage data for their assigned facility. The one-year study will result in a report on strategies and tools. Source: “Saskatchewan kicks off home care teamwork” Marie Mendenhall, Pharmacy Post, November 2005, p. 12.

A-CHAMP promotes cardio health
A partnership of family physicians, pharmacies, public health providers, volunteers and community organizations has launched the Airdrie Community Hypertension Awareness and Management Program (A-CHAMP) in Airdrie, Alta. Targeted at seniors, the program follows guidelines developed as a result of a similar pilot program held in Brockville and Grimsby, Ont. The Alberta team received a $256,000 grant from the Canadian Stroke Network. At the end of the 10-week program, follow-ups of patients who received pharmacist intervention will determine whether the interaction had an impact on their health. Source: “Alberta launches pilot promoting cardio health,” Kristan Wolfe, Pharmacy Post, November 2005, p.14.

PBM focuses on prevention
Medco Health Solutions Inc., a N.J.-based prescription drug benefits manager, is lowering out-of-pocket costs for preventive and chronic medications to consumers enrolled in high-deductible health plans. The new preventive medication programs take advantage of new tax rules that waive deductibles for preventive medications. Heart disease is a prime example of the positive impact of preventive medication: research shows that the use of statins can reduce the risk of heart disease by as much 60% and stroke by 17%. Source: “Preventive health gets a shot in the arm with new consumer driven health efforts from Medco,” Medco Health Solutions, Inc. Press Release (http:// www.medco.com), September 12, 2005.

Patients with rare diseases to access meds
Patients with Fabry's disease and MPS1 (Hurlers Schie disease) will gain access to expensive medications, say Canada’s health ministers. Just when these treatments will become available remains unclear, although ministers will negotiate with pharmaceutical manufacturers to proceed "quickly" with research, including clinical studies for patients with these two rare diseases. Medication to treat Fabry’s disease costs $280,000 per year; for MPS1, $350,000 per year. Drug manufacturers are urging the federal government to develop an orphan drug policy to ensure treatment coverage for patients with rare diseases. Source: “Patients with orphan diseases to get medications,” Kim Laudrum, Canadian Healthcare Manager online (www.chmonline.ca/news/article.jsp?content=20051024_131523_6272), filed Oct. 24/05.

More research on impact of poor compliance
Most private drug plan members prescribed medication for heart disease, diabetes and depression stop taking them soon after they are prescribed, according to a study by Ottawa-based Brogan Inc. from June 2002 to June 2004. For instance, compliance among new users of lipid-lowering drugs dropped to 68% after three months and to 37% by the end of the study period. Lack of treatment for heart disease, diabetes and depression is linked to higher rates of disability and absenteeism, and lower productivity.
Source: “Medication use drops off soon after use,” Don Bisch, Canadian Healthcare Manager online (http://www.chmonline.ca/news/article.jsp?content=20050929_140816_5716), filed Sept. 29/05.

Private payers foot 30% of bills
Healthcare spending by private health insurance companies increased by 51% between 1998 and 2002, reports the Canadian Institute for Health Information (CIHI). Canadians’ out-of-pocket spending on healthcare increased by 28%, bringing total private-sector spending in 2002 to $34.5 billion—30% of the country’s $130 billion total. Canada’s private/public spending split is similar to Germany’s, where the private sector foots 25% of prescription costs and 32% of dental costs. In France, meanwhile, the private sector pays for a relatively low 43% of prescriptions—and a whopping 64% of dental work.
Source: “Private sector foots 30% of healthcare bill,” Nancy Kuyumcu, Canadian Healthcare Manager online (http://www.chmonline.ca/news/article.jsp;jsessionid=CCHCGNLKGFJE?content=20051003_080013_5244), filed Oct. 3/05.

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