Previously the talk around high cost drugs came from biologics and the concern that they might not be able to create generic alternatives. Recently, some generic alternatives have been introduced for some of the high cost biologics and have assisted in bringing the costs down. The new high cost drugs are for Cancer, High Cholesterol and NASH.
Drug adherence and eating incorrectly can be culprits of a cholesterol drug not working. When tests still show high cholesterol, their doctors may think the statins aren’t working and prescribe PCSK9 inhibitors instead. These inhibitors come with a much larger price tag than the statins. Prescriptions for Cancer which were previously prescribed while a patient was in the hospital, these patients are now being treated as out patients and the cost of these prescriptions are being passed onto Employee Benefit Programs.
Benefits Canada’s article on “High cholesterol among key diseases plan sponsors should be aware of” mentions their concern about increased cost for illnesses that are currently inexpensive to treat.
- Do you know or understand what your Experience Maximum is for your Extended Health Benefit?
- Is this Experience Maximum per Certificate or Insured Person?
- What is your Pooled Minimum?
- Does your Pool have a Maximum?
- Are you part of the EP3?
- The cost for the Pooled portion of your benefit program is rising, do you know what you are currently paying for this benefit?
- What are the benefits covered under the Pooled portion of the plan?
Working with your Employee Benefit Program prior to some of these prescriptions hitting your plan can assist in maintaining a comprehensive and cost effective program.
To review your employee benefit program contact Glendinning Insurance Services.