FROM THE TEAM - Changing Landscape
It is interesting to consider the question: at what point does a system or organization recognize that the status quo is no longer its best course of action? In Ontario, it was back in 2005 when the publicly funded Ontario Drug Benefit plan for seniors and those on social assistance recognized that growth in drug plan spending could not continue to increase at four times the rate of tax revenue increase. This realization and the resulting policy changes have been nothing short of monumental in the Canadian landscape. This leads to another question: what is the catalyst for change in the private market dominated by employer-sponsored health plans?
The answer can vary greatly from plan sponsor to plan sponsor. Often, like in Ontario, it is an issue of rising costs. In many ways, changes to control costs are conceptually simple (managed formularies, greater pricing controls, optimized use of cost-effective therapies, tiered cost-sharing, etc.), but can take time to practically implement. Employers also need to consider the impact of plan changes on employee health: poorly conceived solutions can lead to an increase in absence, short-term and long-term disability which cripple productivity and can greatly increase overall benefit costs.
As the Ontario government is experiencing with their current Drug System Renewal process, addressing existing problems is an active, evolving process that involves ongoing analysis and consultation to find the root of the problem and to ensure existing solutions fit both the plan and the external marketplace.
The bottom line is that changing the structure and experience of a drug plan is not simple, if it were, you probably would have already done it. As such, a catalyst must be found within each organization that will allow Human Resource and Finance professionals to recognize the need for plan change. Looking closely at the current plan experience can provide that catalyst.
The private sector can learn a great deal from what public sectors leaders like Ontario have done in altering the plan experience - the key is to avoid the temptation to solve all of the problems in one day. Success will occur by taking smaller bites, prioritizing key issues to address, and committing to an active management process that yields tangible, measurable results that can be built upon.
Sincerely,
Mike Sullivan
President
| DRUG & DISEASE NEWS |
Influenza Immunization in the Workplace
In the last Cubic Health Monthly we provided an update on the impact of the H1N1 virus on the Canadian public. As we draw nearer to the flu season, plans for the release of the vaccine to the H1N1 virus are ongoing. Preliminary discussions indicate that this vaccination may not be targeted to the traditional audience for infection prevention such as adults over the age of 60 years as there appears to be less risk of severe infection in this group. Instead, it is a the young-adult population, along with those known to be generally at high risk due to pre-existing conditions which will be the focus in this case.
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NOC Watch:
Tykerb ® (lapatinib ditosylate)
Zolinza® (vorinostat)
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| FOR THE PLAN SPONSOR |
Proposed Changes to the Ontario Drug Plan and the Potential Impact on the Private Sector
Ontario's public drug programs cover over 2.8 million individuals in the province. Like private plan sponsors, the public drug system constantly faces one overarching challenge: how to ensure the health of its plan population while attempting to contain drug costs. However, unlike the private sector, the Ontario government has started using its buying power to control increasing costs.
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