 |
||
 |
KOHC 120 Eglinton Avenue East, 5th Floor, Toronto, Ontario, M4P 1E2 Toll-free: 866-465-2900 |  |
 |
||
From The Medical Post magazine, Volume 41 Issue 24 June 28, 2005
Compliance no longer just a care concern:
Employee benefit plans facing colossal problem
in skyrocketing drug costs
By Celia Milne - with files from Adam Freill
TORONTO | The rising cost of drug benefits is a bitter pill for employers. And the fact that much of that money goes to waste makes it very hard to swallow.
"The overall picture is quite gloomy," compliance expert Dr. William McLean (PharmD) recently told a room full of experts in medicine, pharmacy, benefits consulting, the pharmaceutical industry, employee benefits and insurance.
"Half of patients are not taking their medications properly and perhaps getting harmed. They need to be spoon-fed, quite frankly," added Dr. McLean, head of the pharmaceutical outcomes research unit at Ottawa Hospital.
Dr. McLean, who is also an adjunct professor in pharmacology in the faculty of medicine at the University of Ottawa, was one of the speakers at Solutions in Drug Plan Management, an annual conference organized by the pharmacy publications at Rogers Media, which also publishes The Medical Post.
Total health-care costs in Canada last year were $130 billion, according to figures from the Canadian Institute for Health Information. The drug portion was $21 billion. Dr. McLean estimated that drug-related problems accounted for $13 billion.
"We're spending 10% of our budget on drug-related problems," he said. For employee benefit plans and private insurers, this is a colossal problem. They pay the largest chunk of prescription drug costs, at 45%.
Provinces pick up the tab for about 40% of prescription costs across the country, while individuals pay for the other 15% out-of-pocket.
Dr. McLean pointed out care enhancement programs, such as those provided by Rx Canada, do help patients take their medications properly, resulting in an average 14% higher compliance. Rx Canada provides e-health solutions for the pharmacy industry. "This is an important finding," he said, "but we still have a long, long way to go."
Who should pay for programs that enhance patient compliance was a topic of considerable discussion at the Solutions conference. In some care enhancement programs, industry pays pharmacists to manage patients taking a particular medication. When it was suggested that employers pay pharmacists extra to monitor care, Imma Monardo, manager of benefits and retirement arrangements at food giant Cara Operations, flinched. "They already get a dispensing fee," she said. "My drug costs are going up 15% to 20% a year. I'm saying, 'Doesn't that cover it?' "
Two occupational health physicians attended the day's events, helping to hammer out some solutions to the problem of skyrocketing drug plan costs: Dr. Noel Kerin, president of Kerin Occupational Health Consultants Inc., and Dr. Eric Rumack, an occupational health physician and disability management consultant.
Dr. Rumack said he was not confident that doctors can be engaged by employers on a large scale to help monitor drug costs and wastage.
"The health-care community doesn't care about costs. In health care, it's an issue of time. Doctors are trained in diagnosis and treatment. The average intervention is, give or take, five minutes. I've been involved with a number of large employers who have tried to reach out to the medical community and have not had success. This is over 20 years."
He suggested that corporations follow the lead of automakers, who have adopted flexible benefits. This brings some accountability to employees because they pick and choose their benefits, instead of getting everything paid for. "I'd like to see better management of resources now or companies are going to opt out of STD and LTD (short-term and long-term disability). We're not going to have any benefits at all."
Dr. Kerin said that in order to control drug costs, it is vital to manage illnesses that commonly occur in the employee population. To do that, companies need better information. "What are your short-term disability numbers? If you don't measure it, you can't manage it. It is amazing the lack of information."
Drs. Kerin and Rumack participated in roundtable sessions that discussed what large, unionized companies can do when they face unsustainable increases in drug costs, as well as high absenteeism. "For this group," said Dr. Kerin, "there's obesity, there's hypertension, there is high blood pressure. If you look at those alone you are going to catch around 70% of the major illnesses that are going to affect these people's ability to continue working. The drug part of that needs to be driven by the diseases you are trying to manage."
He suggested, for instance, that drug costs and disability are linked, so companies need to manage employee attendance in order for disability management to work. "The clinical group needs to look at what it is they are covering. We need to drive down education to the end user."
For instance, he said, "The sooner you diagnose depression the better the outcome is. If a person identifies positive for depression, you need to find a way to get that person to a health-care provider immediately. If you do that, then you are going to reduce the catastrophic costs to the workplace."
© Copyright 2005 The Medical Post. All rights reserved.
Home | KOHC | Memberships | Articles | Legal IME |
Workers IME
Employee IMEs | Cases | IME FAQ | About IMEs | Why Evaluations? | Service Offer
Blog | Contact Us | Privacy | Sitemap
Employee IMEs | Cases | IME FAQ | About IMEs | Why Evaluations? | Service Offer
Blog | Contact Us | Privacy | Sitemap
Kerin Occupational Health Consultants
120 Eglinton Avenue East, 5th Floor,
Toronto, Ontario, M4P 1E2