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Many biologic drugs have a high price tag but they also provide employees a much healthier life and, in some cases, an easier return to work. So how does an employer balance the cost and benefit of biologics on its drug plan?
That was the focus of the panel discussion at the Face to Face Drug Plan Management 2011 conference yesterday, held at the Fairmont Royal York in Toronto.
Jeff Aarssen, vice-president, group retirement services, sales and marketing, wealth management, with Great-West Life (GWL) began the discussion with an anecdote of his personal journey with rheumatoid arthritis. He talked of how supportive GWL has been: allowing flexible work hours (including the flexibility to work virtually when needed), providing an ergonomic keyboard and office chair, and, of course, paying a drug price of $21,000 a year for his chronic condition.
This led into a discussion of the challenges biologics bring for providers, employers and patients.
While it's important to make sure employees are covered for drugs, Tim Clarke, Canada's health and benefits innovation leader with Aon Hewitt, said there are many questions to consider. Is that cost (of a biologic) a priority? Is the benefit worth it? If it is, then the plan sponsor has to look at what it's doing and see where its priorities lay.
Sal Cimino, director, pharmacy services, with Green Shield Canada, agreed. Plan sponsors need to nail down their biologics philosophy, so they know which drugs to cover and how, he said. "If plan sponsors haven't done that philosophical exercise, they should do it."
Another issue is the importance of working together. Sustainability is the elephant in the room, said Cimino, and we're still working in silos.
"It's [determining] how to get different stakeholders all talking and knowing what one another needs to know, how insurers can look at cost savings and what part of government and employer takes ownership for the drug," said Clarke. It's going to take integration's, but who's going to spur that discussion?" asked Cimino.
Mark Rolnick, product director, pharmaceutical benefits, with Sun Life Financial, said that drug plan sustainability is critical from the private/public perspective. "A rare disease can cripple a private plan," he said. "As a small employer, one large claim can have an impact on rates going forward," said Clarke, suggesting that pooling, then, is an option. However, pooling used to be set up as a one-time thing, and now we know these employees will be on these drugs for an extended period of time. There is some discussion going on at the industry level and, to some extent, at the government level, but we're not necessarily there yet, he said.
There is also the issue of cost for the patient. Most of the specialty-type biologics have patient assistance programs-paying upward of 20% of the total cost of the medication-which a patient could be eligible for, said Rolnick.
Kathy Sotirakos, senior market access manager, private insurance, with Amgen Canada Inc., said that Amgen does have such a program that is used on a case-by-case basis. However, she stressed that while the company really does want to continue to do this, it wonders how long it will be able to. Aarssen said that partnership is definitely key. "The power of many is far more important than the power of one," he said. "You can't handle this on your own."
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