Canadian HR Reporter

Affordable benefi t plans are an essential incentive for employees, but currently pose challenges for companies as costs continue to rise and health claims and prescription drug requirements become more complex. As the population ages, the challenge for plan sponsors to balance the health of their members and the cost of offering competitive benefi t and prescription drug coverage will continue to increase. According to the 2017 Drug Trend Report by Express Scripts Canada, 20 per cent of employees are claiming almost 80 per cent of prescriptions drug costs from their employer-offered benefi t plan. This imbalance raises complications in terms of productivity, plan costs and the overall health of these individuals. Communication between the employer and its employees is key to ensuring proper usage of the benefi t plans and understanding of the fi nancial impact and productivity loss that come from non-adherence. The Drug Trend Report found that the people who need their medications the most – the employees who are making 80 per cent of the claims – are also the people who are the least adherent in taking their medications properly. HR professionals, now more than ever, need to be aware of additional support for this group of employees making the most claims to help manage their conditions and treatments so that they are adherent. Companies should work with plan benefi t providers that have active pharmacy services to help tailor programs to address some of the most common chronic conditions in order to reduce absenteeism, loss of productivity and reduce the risk of these employees going on disability leave. HR professionals and employers must also be aware that sometimes these claims are made by employees on behalf of their dependent or spouse. This requires education and open communication to ensure everyone covered in the benefi t plan is properly adhering to their medications and are also made aware of programs and treatments available to them. When only a small group is making the majority of benefi t claims, companies are challenged with how to offset costs. "The Drug Trend Report found that average annual drug spending for these claimants is 15 times that of other employees, to break it down further, the top 20 per cent of claimants represent 79 per cent of plan spending, with an average cost per claimant of $3,386," said John Herbert, director of strategy, product development and clinical services with Express Scripts Canada. When employers react to increases in group benefi t plan costs by choosing to reduce coverage, it negatively affects morale and employee engagement. It also becomes harder for companies to continue to remain competitive and attract top talent. Employees who do not submit many claims feel it is unfair that they need to be penalized by paying more in premiums or having reduced coverage. It is essential for employers to better understand the needs of employees who are high-cost claimants and concentrate efforts on providing them with timely support to manage their condition and drug therapy. Most group insurers now also offer health and wellness apps and tools to further support the employers' efforts in helping employees live healthier lifestyles. Providing encouragement to this group of patients is the best way to control drug plan costs overall. In providing accessible and comprehensible plans, the outcome is better health and a better system for managing the impact of costs on all employees. The Rising Costs and Challenges of Managing Benefit Plans By Stéphanie Myner-Nham

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