Healthcare insurance

Healthcare management initiatives – be proactive!

At Desjardins Insurance1 , we know that the health of your employees and the financial health of your company are important to you. That's why we have taken proactive steps to ensure that your employees and your business are well taken care of.

Drug insurance - where to go from here?

On November 12, 2012, Dr. David Gratzer was interviewed by well-known journalist and television host, Amanda Lang at Desjardins Insurance's Forum 360° in Toronto. Dr. Gratzer delivered a keynote speech addressing the issues surrounding drug insurance and if there are any solutions in sight.

Physician and author of Code Blue: Reviving Canada's Health Care System, Dr. Gratzer is often quoted in the media on health matters, and he has published articles in over a dozen newspapers and magazines including The Wall Street Journal and The Washington Post.

Desjardins Insurance's Forum 360° events discuss current issues in group insurance.

 Transcript

These initiatives include:

Drug utilization review program

For point-of-sale online transactions, this program allows pharmacists to intervene promptly to notify your insured employees about:

  • Dangerous conflicts or side effects from medication
  • Duplicated medication (whether the same medication or equivalent medication)
  • Purchases of the same drug at multiple pharmacies
  • Drugs prescribed by multiple healthcare professionals
  • Drug misuse
  • Inappropriate supply
  • Early renewals

In addition to improving the quality of care, this program can also generate savings of 2–3% on drug costs.1

1 According to data from Express Scripts Canada (ESC)

Hospital drug program

Some drugs are administered at the hospital as they require careful monitoring by a healthcare professional because of the seriousness of the patient's condition, the complexity of the treatment or for safety reasons. In such cases, hospitals must provide the drugs to patients free of charge.

DFS has therefore taken steps to ensure that private plans do not reimburse drugs administered in a hospital (e.g. intravenous treatment), resulting in savings of 1–2%.1

1 According to data from Express Scripts Canada (ESC)

Specialized drug program

When an insured employee gives the pharmacist a prescription for medication covered under a provincial program, the computer system informs the pharmacist that the cost for this medication cannot be reimbursed as it falls under a specialized drug program.

This program's automated mechanisms ensure that you don't reimburse drug costs for insured employees who are eligible for government support.

Generic substitution

Generics are drugs manufactured by other pharmaceutical companies once the original manufacturer's patent for the brand name drug has expired. Generic drugs offer the same benefits as their brand-name counterparts but they are less expensive.

To be approved by Health Canada, generics must be equivalent to the brand name version in terms of quality, dosage and effectiveness. Two drugs may have the same therapeutic effect, but one may cost less than the other. Generic substitution helps keep coverage affordable.

Prior authorization

For certain very expensive drugs, or drugs that might be misused (currently over 100 products), DFS has a prior authorization process to ensure that Health Canada's instructions for use are followed and that patients receive the right drug at the right time.

Process highlights:

  • Drug-specific form available on our plan members' secure site
  • Standardized questions to speed up claims processing
  • Claims processed within five business days
  • Complex cases reviewed by specialized consultants (physicians and pharmacists)

Tiered plans

These plans offer a higher percentage of reimbursement for generics. They help raise awareness about the cost of prescription drugs and encourage insured employees to choose less expensive options.

Fraud

At DFS we take fraud seriously. That's why we have a dedicated specialized fraud and abuse detection team to ensure that the financial health of your plan isn't compromised.

You can count on ongoing monitoring based on the following three pillars:

  • Skilled human resources
  • Rigorous analysis
  • Constant process updates

Pharmacy Benefit Management and home delivery

These services encourage plan members to choose safe, approved, lower-cost maintenance medications, where possible. Maintenance medications are drugs used to treat ongoing medical conditions like asthma, diabetes, high blood pressure and high cholesterol, which account for more than 50% of all drug claims. Maintenance medications are delivered by free standard shipping to the address supplied by the plan member. This could help plan sponsors cut their overall healthcare costs by up to 5% and their costs for chronic health problems by as much as 10%.

Currently not available in Quebec.

1. Desjardins Insurance refers to Desjardins Financial Security Life Assurance Company.

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