Every article I read regarding provincial drug reform leaves me with the same question: are we hanging our hat on the hope that this is the answer to drug plan sustainability? With changes to drug plan management not keeping pace with changes to the pharmaceutical landscape, traditional cost management tools eroded by inflation and becoming less effective with every annual increase to health care premiums, employers are scrambling for solutions to the increasing cost of providing a comprehensive health care benefit. It doesn’t appear that the proposed reforms are going to be the answer. Until plan sponsors, advisors, administrators, claims processors, pharmacy providers, government and the drug manufacturers all step out of their polarized positions and work together to resolve the issue of drug plan sustainability, there is no imminent solution. This leaves plan sponsors “holding the bag” and the bag is getting very heavy.
Without decreasing value to employees, how can a company begin to work towards more effective cost management? The journey towards the desired solution will involve behavioral changes in an organization, starting with those at the top of the pyramid. Plan cost management cannot be viewed by plan sponsors through a narrow, self-sustaining lens. Moving plan members from a philosophy of entitlement to one of co-ownership is the change required to attain the desired solution. This means engaging plan members in managing their costs in order for them to have skin in the game, as opposed to simply transferring increasing costs onto plan members.
Education and communication are crucial to the success of any well-managed program. Do the plan members truly understand the issue of sustainability and the cost of poor consumer choices? Plan members statistically value their coverage and will more effectively adapt to changes in plan design if a thorough understanding of the trends, cost implications and benefits of smart consumerism are readily available.
Having employees participate in the cost of a benefit at point of sale drives better consumer behavior as well as adding a layer of cost containment. Increases in healthcare costs over the last decade are quickly reaching a national average of $2,000 per plan member annually while healthcare plan designs have stayed relatively the same. It is still not uncommon for plans to provide 100 per cent coverage, with no coinsurance or deductible or a relatively ineffective deductible. This scenario offers very little incentive for plan members to help manage their claims cost.
It takes a lot of water to turn a ship around. Until there is cooperation from all of the players in the drug plan arena, plan sponsors will have to make the small changes required to get the ship turning. Changes in the philosophy of an organization and the perspective of the employees will facilitate acceptance of required plan changes. Plan sponsors can begin the process of change by investing the time required to work on building a benefit philosophy and a solid communication plan.