Private Payer Pulse

By: Equilibrium Health  09-12-2011
Keywords: drug, Drug Plan, Drug Programs,

Express Scripts Canada Pharmacy


On November 15, 2011, Express Scripts Canada (ESC) announced that it will be introducing a new pharmacy benefit management business model. Part of this new business model includes

Drug Substitution: Generic, Mandatory and Therapeutic


Drug coverage in private payer drug plans can be influenced by a number of policies that aim to obtain the best value for money for the plan sponsor.

What is a Third Party Administrator?


Third Party Administrators, also known as TPAs, have an important role in the private payer market, yet many of us are not familiar with their activities.

Public / Private Drug Plan Integration Continues


Effective December 1, 2011, Sun Life Financial will expand its drug plan integration process to include

Employer Health Groups: How Can They Work, What Can They Achieve?


A summary written by Hugh Paton, who participated in a panel discussion at the Canadian Pension and Benefits Institute (CPBI) FORUM held in Vancouver on May 20, 2011.

Expanded Integration with Provincial Cancer Drug Programs


Effective June 1, 2011, private drug plan members with Sun Life coverage, living in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, and Prince Edward Island, will be asked to seek reimbursement

Sun Life Policy on Balance Billing to Plan Members by Pharmacies


On March 24th and again on April 4th of this year, we issued bulletins on the issue of ‘balance billing’

ClaimSecure Policy on Drug Cost Mark-ups for Paper Claims


On March 24, 2011, we issued a bulletin on a new policy by BC PharmaCare to limit the drug cost mark-up on selected high cost drugs.

Pharmaceutical Opinion Program and Authority to Renew Refill


On March 15, 2011, the Ontario College of Pharmacists released an Advisory Notice

BC PharmaCare Reduced Mark-up for High Cost Drugs Policy


Effective April 1, 2011, BC PharmaCare will be implementing a policy which lowers the allowable pharmacy drug cost mark-up of certain high cost drugs

Update to Insurer Drug Plan Contracts


Market access and reimbursement within the private payer market are defined by the contractual wording used to define these plans.

Great-West Life: Health SolutionsPlus Use of VISA® Credit Card


To understand the features of Health SolutionsPlus, it is important to understand the role of Health Care Spending Accounts – also known as HSAs.

Sun Life – Enhancing Integration with Provincial Drug Programs


An announcement from Sun Life Financial pertaining to its ongoing plans to ensure that it remains “payer of last resort”

Plan Sponsor-Pharmacy Agreements: RTIP


The Retired Teachers Insurance Plan (RTIP) is a voluntary health care plan designed to meet the needs of retired education workers in Ontario.

Manulife Changes Policy on Limited Use Drugs in Ontario


Effective October 25, 2010, Manulife will enforce coordination of benefits

Plan Sponsor Profile: PSHCP


The Public Service Health Care Plan (PSHCP) is Canada’s largest private group benefits plan at 1.2 million lives (600,000 employees).

Therapeutic Class Reviews: Fueling the Step Therapy Trend


The Canadian Agency for Drugs and Technologies in Health (CADTH) recently published two reports initiated by the Therapeutic Review Pilot Project.

Product Listing Agreement to Remove Step Therapy Criteria


In May 2010, Medavie Blue Cross sent out a letter advising physicians of an immediate change to their Special Authorization criteria for the reimbursement of Remicade.

Private Drug Plan Policies Converging with Public Drug Plans


Manulife has initiated a process that requires patients to seek approval for certain high cost drugs.

Expectations of Private Payers


On April 27, a number of speakers representing different stakeholders in the private payer market presented to an equally diverse audience at the Private Payer Pulse Conference

MOHLTC Changes to Pharmacy Reimbursement


The long-awaited announcement by the Ontario Ministry of Health and Long-Term Care (MOHLTC) as it pertains to generic drug prices

Cancer Therapy Coordination of Benefit


In February 2009, the Annual Report Card on Cancer in Canada released by the Cancer Advocacy Coalition of Canada revealed

Government Control of Generic Drug Prices


In October 2009, the Alberta government announced that new generic drugs must be

Pay Direct Cards to Preserve Brand Sales


A number of brand pharmaceutical manufacturers have had some experience using pharmacy based e-sampling programs through the use of pay-direct cards.

Medavie Pharmacy Agreements


The following news article highlights the reaction by retail pharmacies in New Brunswick against Medavie Blue Cross’ recent

Green Shield Pharmacy Reimbursement Model


At the end of this bulletin, you will see copies of two announcements issued by Green Shield Canada

Vale Inco Drug Plan Changes


As the second largest mining company in the world and the leading producer of nickel, Vale Inco

Telus Health Solutions - Ontario Drug Price Policy Changes


Telus Health Solutions issued a memo to pharmacies regarding their

Alberta Pharmaceutical Strategy: Phase 2


On October 20, 2009, Alberta Health and Wellness (AHW) released Phase Two of its Pharmaceutical Strategy

Remote Drug Dispensing Principles Proposed


At its September 2009 meeting, the Ontario College of Pharmacists Council approved a set of principles

Stakeholder Reaction to Private Payer Listing Agreements


Earlier this year, Green Shield announced new product listing agreements for the

Listing Agreements at Medavie Blue Cross & Green Shield


In April 2009, Medavie Blue Cross announced that the newest drug

Restructuring of North American Big 3 Automakers: Impact on Pharmaceutical Manufacturers in Ontario Part 1 - # Lives Covered Under Benefits Plans


It is somewhat difficult at this time to anticipate the employment landscape for the Big 3 North American automakers in Ontario.

OPDP Monitoring Claims for Ranitidine


Ranitidine (Zantac®) was 1 of the 4 drugs targeted by the Ontario Public Drug Programs (PDP) tendering process

Negotiated Listing Agreements with Employers


Within the Canadian private payer market, the issue of negotiated listing agreements has become enhanced by the prospects of multiple stakeholders

BC PharmaCare Policy Changes - Clarification


This new agreement pertains to changes that will take effect in 2009.

The Alberta Pharmaceutical Strategy


On December 8, 2008, Alberta Health and Wellness introduced its new pharmaceutical strategy. The strategy is a component of the province’s Health Action Plan, and it is designed to make drug coverage more accessible, affordable, efficient and effective for Albertans.

Medavie Blue Cross Coverage of Vasotec


In December 2008, Medavie Blue Cross issued a special communiqué that outlined its position on drug claims by patients older than 65 years of age in Ontario for those products covered by Ontario PDP’s Competitive Agreement Initiative.

Policy Changes with B.C. PharmaCare Program


This new agreement pertains to changes that will take effect in 2009. It includes a process for remunerating pharmacies for clinical services associated with adapting and renewing prescriptions.

Green Shield Copay Changes


It was recently announced by Green Shield that Canadian automotive workers and their dependents will be subject to new copayment rules that come into effect January 1, 2009.

Keywords: drug, Drug Plan, Drug Programs, High Cost Drugs,