Take action on rising drug costs

Prescription drug plan costs continue to increase rapidly in Canada – and it’s a trend that’s here to stay for many reasons:
  • An aging population – with more chronic medical conditions
  • Earlier diagnosis and treatment of health problems
  • Availability of new and more expensive drug treatments
  • Patient-driven demand due to advertising and online information

According to the Canadian Institute for Health Information (CIHI), from 1985 to 2008 total health spending grew at an average annual rate of 6.6 per cent ,and the total spending on drugs during this period increased at an average annual rate of 9.1 per cent.*

This level of spending growth is unsustainable. That’s why Sun Life Financial is pleased to offer BrightChoices Drug Solutions - a suite of smart drug claim management options developed to help reduce increasing drug plan costs and ensure the sustainability of employer sponsored drug plans in Canada for years to come.

Evidence-based drug plan

– a ground-breaking drug plan solution. Our Evidence-based drug plan will push beyond ‘open’ and ‘traditional’ formularies – or lists of prescription drugs – with an innovative multi-tiered model that allows for plenty of choice and reimbursement to plan members for virtually all prescription drugs.

Reformulary Group Inc. has developed the multi-tiered formulary that we use in our Evidence-based drug plan. It has different reimbursement levels based on the health value that a drug offers, and Reformulary Group will negotiate reimbursement from certain pharmaceutical manufacturers. Over time, the combination of drug plan design and negotiated reimbursement should yield significant savings for plan sponsors on their drug plan costs. Read more here.

Mandatory generic substitution.

Generic drugs are clinically identical to the counterpart brand name drug, with the same active ingredients. There is no difference in the quality, purity, effectiveness or safety between generic and brand name drugs, so the level of treatment is fully maintained when using a generic equivalent. Plan sponsors can slow rising drug plan costs, while plan members get reimbursed for the drugs they need.

Prior authorization.

A cost-effective way to manage use of drug treatments that require a more advanced level of scrutiny prior to reimbursement. Prior Authorization helps prevent off-label and experimental use, promotes step therapy starting with the most cost effective treatment, and ensures that there is value in continued therapy. It does not apply to all prescriptions, and it is only required for a small number of drugs taken for certain conditions.

Category caps.

By setting limits in coverage for drugs, such as narcotics, through the management of dispensing (customized by client), category caps provide plan sponsors with claims control and cost containment, while offering flexibility. Customized solutions are available for any drug category of interest.

Provincial integration.

Our enhanced drug claims management process helps ensure that plan members access additional coverage opportunities available under provincial drug programs. For qualified members, the provincial programs will pay before their employer plan.

For more information contact your Sun Life Financial group benefits representative.

*Drug Expenditure in Canada, 1985 to 2010, Canadian Institute for Health Information

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