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Background for Medication Management and Health
Enhancement Program
Challenges for your Drug Plan and Employee Health
Solutions and Strategies for Cost Savings and Health
Improvements
Questions
Agenda
Improve the health and well-being of all employees,
retirees, and their dependents
Support a cost-effective, sustainable drug formulary that
promotes best treatments
Promote wise decision making for improved health and
well-being through education, encouragement and
engagement
Facilitate collaboration and communication between plan
members, employers, community stakeholders, and
health care providers
Med-I-Well’s Guiding Principles
Educate. Inspire. Motivate. Enhance.
Innovative
Medical
Management
Program
Integrated
Health
Enhancement
Program
Improved
Health and
Well-Being
Integrated Approach to Savings
Health
Enhancement
Program
Medical
Management
Program
Improved Employee,
Retiree, and Family Health
• Efficient use of drug plan
• Reduced drug costs
• Reduced claims
• Reduced absenteeism
• Reduced short- and long-term disability
• Reduced health care costs
• Awareness, information, and motivation
• Health enhancement education
Drug Data Analysis, Strategies for Health Enhancement and Drug
Improvement Initiatives
Academic Detailing
MD Update Newsletter
Wellness Newsletter
Health and Wellness Educational
Services and Health Enhancement
Consultations
Consultation to Benefit Department
Occupational Health Referrals and Educational
In-services
Medication Management Programs
What percentage of the people taking
medications are not using them properly?
What is the annual drug cost/ person/ year for
biologic medication used for Rheumatoid Arthritis
(i.e. Remicade, Humira)?
Consider YOUR biggest challenge in regards to
your drug plan/benefits program…
Drug Plan Considerations
Drug Cost Expenditures: Biologic agents, Generic
and Brand, Me-Too drugs
Promotion of Drugs: “A pill for every ill”
Quick Fix versus Lifestyle Changes
Prevalence of Chronic Disease: Diabetes, Mental
Health, Drug Abuse
Aging Work Force
Challenges for Sustainability
Promotion and Marketing of New Drugs
Strategies utilized with Physicians- Wine/Dine,
Research, Advisors/Consultants, Data
availability
Hospital protocols- Therapeutic Substitution
Non-Adherence to Medications
Cost Shifting- Government to Private
Challenges for Sustainability
Monitor and Analyze Drug Costs Annually
Comprehensive Review to determine
opportunities for costs savings
Understand the landscape- Government,
Pharmaceutical companies, Medical
Profession
Engage all stakeholders- education, awareness
and participation
Solutions for the Management of Drug Costs
Generic Rider
Academic and Employee/Retiree Education
Limited Use Program
Prior Authorization
Stepped Care Programs
Assessing Drug Cost and Impact of Positive
Outcome (i.e., RA)
Strategies for Sustainability
Examples and process for significant drug
cost savings and health improvements will
be provided at our presentation on:
Wednesday October 9, 2013 @ 1:30 p.m.
Medications for Heartburn and Ulcers
Proton Pump Inhibitors (PPIs)
Dexlansoprazole (Dexilant®)
Esomeprazole (Nexium®, generics)
Lansoprazole (Prevacid®, generics)
Omeprazole (Losec®, generics)
Pantoprazole sodium (Pantoloc®, generics)
Pantoprazole magnesium (Tecta®)
Rabeprazole (Pariet®, generics)
Name Dose Cost (Annual)
Availability ODB Coverage
Dexlansoprazole (Dexilant®)
30 – 60 mg daily $ 847* 30 mg capsules 60 mg capsules
Esomeprazole (Nexium®, generics)
20 – 40 mg daily $ 682* 20 mg tablets 40 mg tablets 10 mg sachets
$ 839*
Lansoprazole (Prevacid®, generics)
15 – 30 mg daily $ 183 15 mg capsules 30 mg capsules
LU¤ 293, 295, 297, 401, 402
fastabs: $ 745*
15 mg fastabs 30 mg fastabs
Omeprazole (Losec®, generics)
20 mg daily $ 201 10 mg tablets 20 mg tablets
10 mg capsules 20 mg capsules
LU¤ 293, 297, 401, 402
$ 843
Pantoprazole sodium (Pantoloc®, generics)
40 mg daily $ 184 20 mg tablets
40 mg tablets LU¤ 293, 295, 297, 401, 402
Pantoprazole magnesium (Tecta®)
40 mg daily $ 274 40 mg tablets
Rabeprazole (Pariet®, generics)
20 mg daily $ 122 10 mg tablets 20 mg tablets
= general benefit, = not covered, LU = Limited Use, ODB = Ontario Drug Benefit *Cost per McKesson wholesaler, ¤Limited Use (LU) Codes27:
Example of Limited Use Code
Advancing our Efforts
Since large proportion of claims are for the least
expensive PPIs, focus is now on reducing claims
through improved plan member health and
reduced prescribing
Ongoing academic education on PPIs and
caution relating to long-term side effects
Employee health enhancement presentations
Webinars
Health Risk Assessment
program
Library of Webinars
Medication and Wellness
Education
Develop and implement
successful Wellness
Challenges
Chronic Pain and Medication
Consultation
Occupational Health Referrals
Shift Work Reviews
Fatigue Risk Management
Health Enhancement Programs Building Sustainability & Resilience
Feedback- Manager of Benefits
“When we saw these numbers we knew we needed
to focus on the “health” side of things to
complement our operational focus on safety-This
will align us with our value of Health and Safety for
All.”
“With the significant interest and participation in
these health oriented programs, we are looking at
creating a cultural shift in our workplace”
Employee Feedback on Healthy Weight Challenge
“ I take care of meals at home and I’ve really turned
a new leaf as to what kind of choices we make at
the grocery store and in taking more time to plan
meals. I want to be an example for my family and
this is a lifestyle change that will carry forward after
the three months are over. We are lucky to work for
an employer who supports us in this effort.”
THANK YOU
