RBC Insurance plans to launch a preferred pharmacy network (PPN) for specialty drugs on May 1. The insurer says the program will reduce costs for employers' drug plans by 3% to 4%.
In a recent message posted to its web site, RBC notes that drug prices have been increasing and are pushing up costs for private and public drug plans alike, while at the same time the pharmaceutical industry continues to introduce new specialty treatments.
Drug technology is revolutionizing treatments
"This new drug technology is revolutionizing how a number of serious medical conditions are being treated, such as rheumatoid arthritis, multiple sclerosis, cancer and hepatitis C," notes RBC. "The medications prescribed allow patients to significantly improve their quality of life, with many being able to return to a productive lifestyle, including work. But for drug plan sponsors, this new technology means high drug claims costs, often in tens of thousands of dollars per claimant, per year, or more."
In order to cope with these higher costs, the new program will require claimants to obtain their specialty medications from an approved network pharmacy. Those who choose to go to a pharmacy that has not been approved will not be reimbursed under their drug plan.
RBC has partnered with HealthForward, a subsidiary of AmerisourceBergen Canada, to deliver the program by managing the network of participating pharmacies, coordinating access with claimants, providing support services, and communicating with healthcare providers. RBC says that Green Shield Canada (GSC), which currently handles its claims administration, will continue to adjudicate all specialty drug claims in its PPN program.
Low number of claimants
"The percentage of total drug claims associated with specialty drugs in the PPN program is fairly high, currently representing about 18% of RBC Insurance's total drug claims cost," reads the message on the RBC web site. "However, the number of claimants with specialty drug claims is small; currently less than 1% of RBC Insurance drug claims are for specialty drugs. So while the PPN will have a significant financial impact on managing claims cost for plan sponsors, the disruption to our claimant population is minimal."
The insurer notes that the program is for plan sponsors with a pay direct or deferred drug plan, and says it will not be available in Quebec.