Working together to maintain effective and sustainable drug plans

The key to a drug plan’s success is finding the right balance between access to treatment and sustainable costs. For effective drug plan management, it’s important to consider the entire drug plan, not just each component individually. The Co-operators helps plan sponsors manage drug plans by:

  • Providing access to programs that monitor and coach patients towards their best possible health outcomes
  • Ensuring patients receive the right drug at the right time
  • Offering drug management solutions, cost-sharing arrangements and built-in claims administration features

Partnerships with industry leaders to provide support services

Through our partnership with HealthForward Inc., we support plan members by:

  • Helping to manage specialty drug prescriptions and out-of-pocket expenses
  • Having a care co-ordinator direct the plan member to their local approved network pharmacy to fill their specialty drug prescription
  • Managing side effects that may be a barrier to treatment
  • Providing referrals to manufacturer support programs to further reduce cost

In partnership with Cubic Health Inc. and the FACET Program, we aim to ensure the right drug is prescribed to the patient at the right time to achieve the best possible outcome. The FACET Program has identified that a significant percentage of initial claims processed are prescribed inappropriately. To combat this issue, the program provides support services though a team of clinical pharmacists who promptly review cases to determine if a more effective and affordable option is available. This process realizes an average savings of $10,000 per claim reviewed.

Drug management solutions

To ensure members have drug plan options to suit their needs we offer:

  • A range of drug formularies that allow members and their families to access effective treatment
  • Coverage options that can be customized to meet the plan sponsors’ needs and budgets
  • A variety of cost sharing arrangements

Our dynamic maintenance programming limits the initial reimbursement of acute medications to a 34-day supply for the first two consecutive prescriptions to reduce waste. The program allows a 100-day supply of maintenance medications to be dispensed and eligible for reimbursement to reduce the dispensing fees associated with filling these prescriptions monthly.

Drug utilization rules screen every prescription for issues, such as drug interactions, over-utilization and early refills. By monitoring for mistakes or oversights, treatment outcomes can be improved.

Reasonable and customary drug pricing allow reimbursement up to a set amount based on what’s reasonable and customary in the market for the cost of a drug and its retail mark-up.

Reasonable and customary limits ensure usage is managed on items such as migraine medications and diabetic test strips, to protect the plan from the cost of unnecessary supply amounts.

The Co-operators is committed to partnering with plan sponsors to support the health and well-being of plan members, within defined budgets. If you have questions or need more information, contact your Group Benefits Representative

New EI parental sharing benefit

Learn about the new EI sharing benefit, made effective March 17, 2019.