PDCI Market Access, a Division of McKesson Canada Corporation has released a whitepaper investigating the design and sustainability of private drug benefits in Canada. The report, commissioned by Innovative Medicines Canada, uncovers critical gaps in private insurance risk pooling that leave many small plan sponsors with tough decisions impacting the future sustainability of drug benefits.
The report: “Issues and Opportunities to Modernize Private Drug Plan Sustainability in an Evolving Market” explores:

• Current challenges and opportunities for stakeholders, including plan sponsors, benefits advisors, employees or plan members, insurers, government, and prescription drug manufacturers.
• Options for stakeholders to collaborate on solutions to optimize Canadians’ access to innovative medicines and balance the need for affordability and sustainability of the insurance infrastructure.

The whitepaper identifies the following key takeaways:

• The private drug insurance market is approaching a crossroads. For a growing number of private plans, the current approach for high-cost claimants inefficiently distributes their associated costs on plan sponsors with high-cost claimants.
• As biopharmaceutical manufacturers launch new medicines in Canada – many being the first to meaningfully address critical or rare conditions – an increasing number of private drug plans experience claimants with higher costs.
• Change is needed to ensure effective distribution of risk that enables affordable and broad participation by private plan sponsors.
• A modified more efficient and equitable risk-sharing approach will
  1. Support fully insured plan sponsors with members experiencing high costs to ensure their members receive the medicines they require,
  2. Provide new affordable options for small to medium-sized employers that purchase administrative service only or refund accounted plan types with stop-loss pooling, and
  3. Equitably and effectively share risks ensuring all sponsors continue to offer competitive and comprehensive benefits programs to their members.

In this whitepaper we discuss options for stakeholders to collaborate on solutions that optimize Canadians’ access to innovative medicines while balancing the need for affordability and sustainability of the private insurance infrastructure.

Download and Read the FREE Report here.
Contact Paul Henricks, Associate Director, Data Innovation and Insights for any inquiries and feedback regarding this Report.