FROM THE TEAM
Keeping Pace With Progress
Research and development into innovative treatments for various medical conditions continues to yield novel drug therapies. Advancements in chemotherapy allow us to often regard cancer more as a chronic condition than a terminal illness. With Gardasil®, we now have the first vaccine indicated for the prevention of cancer. Furthermore, the development of specialty biological therapies that focus on the root cause of conditions such as rheumatoid arthritis and multiple sclerosis, rather than symptom management for these progressive diseases, has given patients new hope for the future.
Of course, all of these advancements come with a cost that reflects the extensive work required for R&D. The question now becomes: how can the impact of progress be realized if progress cannot be afforded?
This should give Canadian plan sponsors pause, as they consider whether their traditionally designed drug plans are performing well enough to be sustainable in the long-term, and whether these designs accurately reflect the intended coverage for plan members. Intuitively, many sponsors would support coverage of a relatively affordable product that prevents someone from a diagnosis of cancer. Yet, as a vaccine, Gardasil® will be excluded from coverage for many due to their existing plan design. Another potential roadblock to plan inclusion for a cancer preventing vaccine could be cost. While Gardasil® is expected to cost hundreds not thousands of dollars, unless cost-effectiveness is sought and realized elsewhere in their plan designs and formularies, there simply will not be the necessary funds available for plan sponsors to afford these types of products in the future.
Reaping the benefits of these novel therapies requires a novel approach to managing the private drug plan - one that is more assertive, and one with more active involvement of plan sponsors and their plan members. Drug therapy is far more dynamic now then it ever has been. Active plan management is key to ensuring cost containment is kept front and center, but at the same time, that appropriate therapies are made available to plan members. That cannot be achieved by excluding entire classes of drugs, and never coming back to revisit those exclusions. At the same time, open plan designs, that by default include any new therapy, leave plan sponsors defenseless against significant cost increases. Plan sponsors have little option moving forward, outside of active plan management, if they want to ensure strong financial performance through cost containment without adversely affecting plan member health and productivity.
To pass along any comments on Cubic Health Monthly, or to see back issues of our publication, please visit our website at http://www.cubichealth.ca.
Sincerely,
Chris von Heymann
Senior Vice President, Consulting Services
| LATEST NEWS |
Flu Vaccine Delay in Canada
Public health officials have informed the provinces and territories that flu vaccination programs in Canada will be delayed this fall by up to one month because of industry-wide production problems. It is not expected that the delay will jeopardize the extensive provincial and territorial flu shot programs which are estimated to vaccinate more than 11 million Canadians each year.
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| DRUG & DISEASE NEWS |
NOC Watch:
Nexavar® (sorafenib tosylate)
RotaTeq® (Rotavirus Vaccine, Live, Oral, Pentavalent)
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| FOR THE PLAN SPONSOR |
Vaccines: Do Plan Designs Still Reflect Intended Coverage?
With the issuance of its Notice of Compliance (NOC) by Health Canada on July 10, 2006, the entry of Gardasil® to the Canadian market may open a drug plan coverage debate for plan sponsors. Gardasil® (quadrivalent human papilloma virus recombinant vaccine) is a new vaccine that targets human papilloma virus (HPV), which is responsible for most cases of cervical cancer. It is also indicated for preventing a number of other problems that HPV causes including cervical lesions and genital warts. However, the vaccine has received the most attention for helping to prevent cervical cancer.
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Plan Sponsors with No Current Concerns with Drug Plan Costs
– What Now? (Part 2)
Those plan sponsors who are fortunate enough to be in a position where drug plan costs are manageable, and the rate of cost increase in this area is not a source of concern, have a tremendous opportunity to focus proactively on risk management. This is a far more enviable position than having to focus on putting out financial fires brought on by unexpected plan cost increases in the current period. However, the very nature of the demand side of the equation within the prescription drug plan makes a lack of focus on proactive risk management a potential for significant financial consequences related to plan utilization in the future.
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August 2006
Issue No. 15 |
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QUICK FACTS
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Estimated number of new cancer cases in Canada, 2006:
153,100
Estimated number of deaths from cancer in Canada, 2006:
70,400
Regions in Canadian with the highest incidence and mortality rates from cancer:
Atlantic Prov's and Quebec
Region with the lowest:
British Columbia
Based on current incidence rates, percentage of Canadian women that will develop cancer during their lifetimes:
38%
Percentage of Canadian men:
44%
Based on current mortality rates, number of Canadians who will die from cancer:
1 in 4 |
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