Canadian HR Reporter

CANADIAN HR REPORTER AUGUST 2018 16 NEWS pharmacare plan — a publicly funded program that would re- place the country's existing pub- lic drug plans and employment- based private drug plans in some fashion. "Ensuring access to prescribed medications is vital from both a health equity and health outcome perspective," said Hoskins. "Too many Canadians are unable to maintain or achieve a healthy life because they cannot aff ord need- ed prescription drugs." While the conversation is gen- erally positive, it's also full of com- plexity, said Mike Sullivan, CEO of Cubic Health, a drug plan analyt- ics fi rm in Toronto. "It isn't reasonable that you can have such disparate coverage across the country," he said. A national pharmacare plan in any form will be no "magic bullet" for employers, said Sullivan. "When it comes, I think they might be underwhelmed by the solution… I don't think pharma- care is going to be necessarily what they think it is." e advisory council will engage with various stakeholders, includ- ing governments, health-care pro- viders, patients and businesses, said Irina Andritoiu, a commu- nications advisor with the federal government in Gatineau, Que. In 2016, the parliamentary budget offi cer estimated the im- plementation of a national phar- macare program would cost $19.3 billion, based on a framework similar to Quebec's formulary, eligibility requirements and co- payment levels. A Liberal or NDP-led pharma- care program will likely promote the government as first payer, while a Conservative model would be a second-payer, fi ll-in-the-gaps system, according to Sullivan. A fi rst-payer system would be the more diffi cult road in terms of constructing a common drug formular y across provincial boundaries and facing lobbying pressure from pharmaceutical companies and insurance carri- ers, he said. "It's a massive undertaking — which isn't a reason to shy away from it," said Helen Stevenson, CEO of the Reformulary Group in Toronto. "We're either going to have a program that's going to ad- dress the gaps, or we're going to… collapse everything and create one big program that's going to put ev- erybody onto the same formulary." Bracing for change Ensuring all Canadians have ac- cess to prescription drugs is im- portant, said Henry Toby, On- tario president of Gallagher, a benefi ts and HR consulting fi rm in Toronto. "When you look at the patch- work of critical-care programs that virtually every province has, there is access to it, but it's dif- fi cult, it's onerous," he said. "A national pharmacare approach would, without question, stream- line a lot of this, make it adminis- tratively far more feasible and re- alistic... For employers, it's almost impossible at this juncture to say what the impact will be." Streamlining pharmacare could allow the federal government to save money on medications by using its large scale and scope to drive prices down, said Toby. But with 23 million Canadians already holding some form of drug plan, a national pharmacare over- haul is not needed, said Skinner. " is is a massive, disruptive and expensive program that is completely unnecessary and bad for patients. It's not going to be any improvement for those who already have access to benefi ts. It's going to be the same or worse." A shift to a national pharma- care plan would wreak havoc on benefi ts plans, he said. "If you're part of the private insurance in- dustry, this is obviously the death knell for your industry in terms of drug insurance coverage in Canada." And employers could struggle to have a "meaningful voice" in the discussion process, said Sullivan. "They're such a fractured group. You've got small employ- ers, medium-sized employers, large self-insured employers," he said. "There's such a fractured group of plans that it's hard for them to ever get united." Employers will need to ensure drug plans and off erings have an appropriate design and frame- work to ensure they are not pay- ing for drugs that would go un- supported under a pharmacare model, said Sullivan. "At the end of the day, if (em- ployers are) holding the bag with a bunch of really bad drug plan risk that nobody else is going to pick up the cost, they're likely go- ing to have to continue paying for it, or they're going to have to have a tough conversation with their plan stakeholders." Studying plan design to ensure optimal spend could allow em- ployers to benefi t if pharmacare does become a reality, he said. Advice for HR National pharmacare could be a major tenet in the federal Liberals election campaign next fall, said Skinner. With this in mind, it's up to HR to "get in front of the issue and start educating employees — the beneficiaries who have public drug plans," he said. Additionally, employers will need to seriously consider the amount of supplementary cov- erage off ered if the pharmacare landscape is to be altered, said Stevenson. If the national plan implements a structure similar to the 4,400 es- sential drugs included within the Ontario Drug Benefi t Program, employers may need to continue picking up uncovered drugs. " at area of coverage is a really big consideration," she said. Some employees may begin pushing for more benefi ts, be- lieving their employer is now off the hook for drug spending, said Sullivan. HR could avoid such a scenario by sending out appropriate com- munications "so members have a realistic expectation about some of what they're dealing with." "Pharmacare is going to be a bit of a curse and a benefi t for plan sponsors," he said. "But I don't think the benefi ts are going to come for a number of years, and they're go- ing to have to deal with some of the other fallout right away." "Make sure that your ben- efi t plan or drug plan that you're redesigning is thoughtfully done so that it's in line with the kinds of decision-making that would be normal with a pharmacare plan." Upheaval for benefi ts plans PHARMACARE < pg. 1 Ontario reverses policy on OHIP+ One day after assuming offi ce on June 29, Ontario Premier Doug Ford announced a shift away from the province's recently implemented pharmacare strategy which made the provincial government fi rst payer on prescription medicines for all citizens age 24 and under. While children and youth not covered by private benefi ts will continue to receive eligible prescriptions for free, those covered by private plans will once again bill their plan sponsor or employer fi rst. The move means the previous administration's plan to begin offering free prescription drugs to seniors over age 65 is also off the table, said Mike Sullivan, CEO of Cubic Health, a drug plan analytics fi rm in Toronto. "OHIP+ is only going to cover the gaps for people who don't have adequate coverage or can't afford it." The move won't have much of an impact on employers, essentially requiring them to pay slightly more for prescription drug claims made through benefi t plans, said Henry Toby, Ontario president of Gallagher, a benefi ts and HR consulting fi rm in Toronto. "It was almost a non-event for employers in the initial setup," he said. "Now that they're fl ipping back… I don't think too many employers are going to be put out by it." OHIP+ covers the 4,400 drugs included within the Ontario Drug Benefi t Program. Employers could struggle to have a "meaningful voice" in the process. LOOKING FOR A SUPPLIER OR VENDOR? 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