Reformulary

Your Group Benefits clients have the opportunity to control drug plan spending and protect the sustainability of their Extended Health Care plan with a new evidence-based drug plan option.

There’s a misconception that newer and often more expensive drugs are more effective than existing medications. As new and more expensive drugs are added to traditional drug plans, many employer-sponsored drug plans are experiencing a real and significant strain. Left unchanged, many drug plans are at risk of becoming financially unsustainable.

The Co-operators has partnered with Reformulary Group to offer our clients the Reformulary®. The Reformulary is an evidence-based drug plan that helps plan sponsors reduce their drug plan spending without compromising the quality of their plan or the level of treatment their members receive. Savings vary by group, but plan sponsors who are currently using the Reformulary are seeing measurable savings on their drug plan spending.

The Reformulary takes a tiered approach to drug plan coverage. Medications listed in the Reformulary have been evaluated by expert doctors and pharmacists who have placed them into one of three tiers based on their cost and clinical effectiveness. The cost savings come from offering different reimbursement levels for each tier.

The Reformulary engages plan members in cost containment by offering them a choice:

  • Take a preferred (tier one) drug and pay less out of pocket
  • Continue taking a non-preferred (tiers two and three) drug, but pay a higher co-pay than the preferred alternative

Plan members control how much they pay. There is a preferred drug option for each chronic medical condition (such as high blood pressure), so plan member treatment is not compromised. Medications (such as antibiotics) used to treat acute medical conditions are also covered by the plan, but aren’t included in the Reformulary. Members pay the lowest co-pay for these drugs.

The Reformulary is supported by comprehensive plan member communication, including DrugFinder, an online resource to help plan members choose the best value (preferred) drug for their medical condition. It also includes resources to help plan members initiate conversations with their doctor or pharmacist about choosing preferred drugs.

Click here to learn more about the Reformulary. Contact your Co-operators representative to find out if the Reformulary is a good fit for your clients.

Why one should consider Generic Drugs

Health Canada ensures that generic drugs are equivalent to brand-name options. Many factors contribute to the higher price of brand-name drugs, such as the cost of marketing and development.

Anti-fraud initiatives protect your clients

The Co-operators is working with the Canadian Life and Health Insurance Association (CLHIA) to provide input into the anti-fraud task force within the Ontario Auto Association. This initiative is another way we are demonstrating our commitment to protecting your clients.