CSCM PARTNER
difficult to replace. In addition, many older workers in Canada still
desire to remain in the workplace, and their reasons are not only
financial. Now that people are living longer, the idea of not working
after age 65 can lose its appeal.
3. Chronic diseases
Chronic conditions become more prevalent with age, causing a
disproportionate health burden on seniors. Despite technological
advances in prevention and treatment, more than half of Canadian
adults are struggling with at least one chronic condition, which
can negatively affect their quality of life on a daily basis.
The pharmaceutical industry has evolved considerably in
the field of chronic diseases, particularly with the introduction of
“specialty drugs”. From this need, the new pharmaceutical technology
biologics were born. They contain a substance made in
the laboratory from a living organism and are designed to interact
with specific targets in patients. Biologics are used to fight serious
illnesses and diseases such as rheumatoid arthritis, multiple sclerosis,
cancer and hepatitis C. Untreated, chronic conditions can
lead to functional limitations and severe disability, which have a
significant impact on the quality of life, physically, emotionally and
mentally. Those for whom total remission is unrealistic want to
have enough control over their disease to allow them to live a life
that is as productive and pain-free as possible.
The benefits of biologics are therefore not to be minimized,
as they can significantly improve a person’s quality of life, enabling
many to regain a productive lifestyle, including their ability to
return or be more productive at work.
Although this new technology definitely has its perks, it also
results in high drug claim costs, typically in the tens of thousands
of dollars per claimant, on an annual basis. Even though the number
of claimants using specialty drugs is low (less than one per
cent, according to insurance industry data), the percentage of total
drug claims represents approximately 18 per cent of the total cost
of drug claims.
The existing data from a large sample of private clubs that
have prescription drug coverage in place indicates the following
top five drug types:
1. Cardiovascular
2. Diabetic
3. Anti-infective agents
4. Psychological
5. Dermatological
The facts are that the population is aging at an accelerated
rate, chronic illness is taking a toll on Canadians and biologic
drugs continue to grow in number and popularity because of
their groundbreaking effects. In light of the challenges facing
our healthcare system, can anything be done to help employers
contain costs?
According to the 2018 edition of The Sanofi Canada Healthcare
Survey, four out of five (83 per cent) plan members with chronic
conditions take at least one medication on a regular basis, and 37
per cent take three or more. Of these, some 40 per cent admit that
when taking multiple medications, they sometimes forget to do so
as prescribed. This common scenario often leads to false results in
treatment plans, worsening of conditions and additional costs on
drug plans.
The recent introduction of provincial legislation granting
pharmacists a broader range of services in their practice, coupled
with the recent growth of online pharmacies with personalized
communication channels in Canada, is an opportunity for
increased dialogue and improvement of health outcomes. In fact,
a high percentage of individuals taking medications for chronic
diseases are receptive to coaching from pharmacists and other
medical professionals and would like to know more about their
condition and how to treat it.
While traditional wellness programs can alleviate some of the
struggles being experienced by members with chronic diseases,
there are now personal risk assessments regarding diseases, which
have become widely sought after by members. The majority of
insurance companies now provide online health-risk assessment
programs to better understand, manage and seek better lifestyle
choices. More specifically, it provides a navigational tool to the
Canadian healthcare system by providing access to the following
resources/information:
• Research hundreds of illnesses and treatments
• Understand provincial health coverage and public programs
• Locate family doctors, specialists and facilities
• Discover alternative solutions and reduce your drug costs
• Engage in a health assessment questionnaire to identify any
health risks
It becomes apparent to most advisors reviewing a club’s group
insurance contract that there is a high number of employees that
remain employed by a typical private club for many years, and
sometimes for an entire career. These situations certainly bring value
added benefits to both management and your club members.
However, years of service also translates into an older workforce
with the added possibility of experiencing chronic illnesses.
At the plan sponsor level, plan design features such as those
noted below can help offset the increase in drug costs on health
plans without limiting plan member access to effective drug treatments.
These include:
• Prior authorization
• Preferred provider networks
• Managed formularies
• Mandatory generic substitution
• Dispensing fee caps
To empower the plan member with the appropriate tools and
information to make an informed decision on his/her healthcare
needs is vital to the solution of a sustainable program. While the
interaction between your employee, club management and healthcare
providers such as doctors and pharmacists will remain in
place for the future, technology and innovative platforms will help
to maximize healthcare efficiencies for all Canadians.
The saying rings true: an ounce of prevention is worth a pound
of cure!
Jules Fiorini is a senior group insurance plans advisor and group
insurance and group annuity plans advisor at BFL CANADA
Consulting Services Inc. He has more than 20 years of experience
in group insurance programs, which includes financial analysis of
plans, costs control, strategic planning, creation and implementation
of flexible plans.
32 § The Canadian Society of Club Managers § www.cscm.org
/www.cscm.org
