MULTI PRODUCT BROCHURE THE PRODUCT An annual brochure produced by Manulife’s Group Benefits business to educate plan sponsors (ie clients) on trends in the pharmaceutical industry and how they impact group benefit program costs. THE CHALLENGE Similar to the retirement transition brochure, my team was provided with a cumbersome amount of information. The previous years’ brochures were very dry and industry jargon-heavy. Targeted at key decision makers, the challenge was to create a piece that would engage them, without requiring very busy people to dedicate a significant amount of time to reading it. THE SOLUTION We took a similar approach to the retirement project, and created a magazine layout, again breaking the information down into topics that could be read independently. We also educated the product team on how to minimize the amount of industry jargon to make the copy more engaging and reader friendly. OUTCOME The magazine was rolled out at one of the biggest Group Benefits trade shows early in 2015, and was very well received by both industry specialists and clients. The marketing team is already working on next year’s edition. `
Transcript
M U L T I P R O D U C T B R O C H U R E
THE PRODUCT
An annual brochure produced by Manulife’s Group Benefits business to educate plan sponsors (ie clients) on
trends in the pharmaceutical industry and how they impact group benefit program costs.
THE CHALLENGE
Similar to the retirement transition brochure, my team was provided with a cumbersome amount of
information. The previous years’ brochures were very dry and industry jargon-heavy. Targeted at key
decision makers, the challenge was to create a piece that would engage them, without requiring very busy
people to dedicate a significant amount of time to reading it.
THE SOLUTION
We took a similar approach to the retirement project, and created a magazine layout, again breaking the
information down into topics that could be read independently. We also educated the product team on
how to minimize the amount of industry jargon to make the copy more engaging and reader friendly.
OUTCOME
The magazine was rolled out at one of the biggest Group Benefits trade shows early in 2015, and was very well received by both industry specialists and clients.
The marketing team is already working on next year’s edition. `
EXPANDINGyour knowledge of priorauthorization
My drug plan goes where members go, and more ...
Striking the right balance between cost management, health outcomes and the plan member experience
SPECIALTYDRUG CARECost savings and case management
Happy, healthy employees can lower drug spend for employers
A M E S S A G E F R O M G O D F R E Y M A U
Striking the
BALANCEThe pace at which pharmacy benefits are evolving reflects the need to deliver more value for every health care dollar you spend. More than ever, plan sponsors are considering drug benefit plan changes to help manage costs without impacting health outcomes and the plan member experience.
During the last several years, the ‘patent cliff,’ a period of time where a large number of blockbuster medications have lost their patent, has paved the way for generic versions to enter the market. The patent cliff, coupled with provincial drug reforms regulating the price of generic drugs, has controlled the growth of drug costs. This has benefited plan sponsors, but masked the continued rise in the use of specialty medications.
Specialty medications used to treat complex health conditions are often medical breakthroughs, but come at a significant cost. Take, for instance, the new drugs for the treatment of hepatitis C. These therapies promise a cure for the majority of patients with hepatitis C; however, they can cost more than $60,000 per treatment. Given that there are an estimated 250,000 Canadians with hepatitis C,1 these therapies represent a significant cost to drug plans.
When you consider that approximately 60 per cent of drugs in development are specialty medications, the benefits of the patent cliff and provincial drug reform will not offset the upward trend associated with the tsunami of specialty drugs.
While most drug plans have some form of pooling to help protect against these high cost claims, this protection has traditionally represented a small percentage of the total cost associated with a drug plan. Now a growing percentage of claims will hit the pooling threshold due to the surge of high cost drugs. If plans are left unchecked, plan sponsors could see material increases in their claims experience and significant increases in pool charges.
1 Canadian Liver Foundation
Godfrey joined Manulife in April 2014 and supports client initiatives related to pharmacy benefit management. He is a graduate of the University of Toronto’s pharmacy program and began his career practicing in hospital pharmacy. Since then, Godfrey has held a variety of roles in the private sector and corporate pharmacy, and has been responsible for product development, marketing, sales support, and formulary management. He continues to maintain an active pharmacist license and practices in both retail and hospital pharmacy.
BALANCING pharmacy benefitsManaging rising drug benefits costs
Making certain your pharmacy
benefits program can bear the
pressures of the new high cost drugs
can be challenging. We’re pleased
to offer solutions that not only help
manage pharmacy benefits program
costs, but may result in increased
plan member productivity and high
employee engagement!
We can help support effective management of your drug plan
The choice of a broad range
of cost management
solutions
Services that promote employee
health
Delivery of resources that encourage member experience
and engagement
BY OFFERING...
This trend doesn’t have to threaten the sustainability of drug plans. Plan sponsors have the opportunity to evaluate their current benefit plans and ensure they’re putting the right measures in place to protect them for the future.
At Manulife, we’ve been busy introducing and updating our solutions to help you control drug plan costs. These include:
■ Expanding our list of prior authorization drugs (page 9),
■ Adjusting the reasonable and customary limits in Quebec (page 13), and
■ Negotiating our first product listing agreement for the drug, Remicade® (page 14).
We’ve saved the best for last: Manulife’s Specialty Drug Care program (page 7). We’re proud of this recent initiative as it’s not only designed to help manage complex medical conditions, but also provides savings on high cost specialty drugs for both you and your plan members. Everyone benefits.
In the following pages you’ll find updates on our programs and how we’ll help you sustain your drug benefit plan. We’ll continue to play an important role in helping to manage your drug plan expenses. And of course, our ongoing commitment is to continue monitoring the pharmacy benefits landscape and offer solutions that strike the balance between cost management, health outcomes and a positive plan member experience.
Godfrey MauPharmacist Consultant, Group Benefits and Retirement Solutions Manulife
n W H A T ’ S T R E N D I N G
Updates on what’s affecting the pharmacy landscape and your drug benefits plan.
3 Medication adherence
More than just dollars at risk.
5 Subsequent entry biologics
A lot more complicated than generic drugs.
n C O S T M A N A G E M E N T
Managing costs ensures you and your plan members get the best value for dollars spent.
7 Savings, services and improved health outcomes with Specialty Drug Care
9 Expanding your knowledge of prior authorization
11 Express Scripts® Canada
Canada’s Home Delivery program – the active pharmacy difference.
12 Save at Costco®
13 Reasonable and Customary savings in Quebec
Limits on pharmacy markups and dispensing fees help improve cost savings.
14 Remicade® A new partnership brings greater value.
WHAT’S INSIDE
Our promiseManulife Group Benefits is committed to helping plan sponsors find solutions to challenges that threaten long-term
sustainability of their drug plans. We’ll continue to offer choice and flexibility, with appropriate claims administration
practices that benefit everyone. We’re dedicated to providing regular updates on our progress and introducing new
areas of focus. As a premier health benefit manager, we understand the health of plan members is key to supporting
any successful business.
n P L A N M E M B E R E X P E R I E N C E
Resources and tools to help plan members understand their drug benefits plan, take advantage of savings and reduce your costs.
15 My drug plan
Coming soon! This tool does more than just answer your plan member’s questions.
n H E A L T H M A N A G E M E N T
Solutions to help employees become healthier, more productive and engaged at work.
16 The case for case management
Manulife’s Specialty Drug Care can provide savings, but the heart of our program is case management.
17 Managing mental health in the workplace
19 Health Risk Assessment (HRA) enhancements
21 Claims Management at a glance
WHAT’S INSIDE
Risk factor reduction can lower drug spend and absenteeism
A pilot study of a comprehensive workplace wellness program found reduction across 11 health risk categories had a positive impact on both absenteeism and drug costs.
Further, employees moving from low to high risk showed a relative increase of
81% in drug costs and 160% of absenteeism costs.
Makrides, L., Smith, s., allt, J., Farquharson, J., Szpilfogel, C., Curwin, s. et al. (2011)
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n W H A T ’ S T R E N D I N G
Medication adherenceMore than just dollars at risk.
It seems straightforward. A health care professional prescribes drugs. The patient takes the drugs as prescribed. Simple, right?
Maybe not. Non-adherence occurs when people don’t take their medication exactly as prescribed. And that’s exactly what’s happening. It’s become a substantial problem with significant consequences.
Not only do patients miss the full benefits of their medications, they put their health at further risk. And that means more trips to the doctor, which increases costs to our health care system and employer-sponsored benefit plans. It can also mean greater lost productivity, absenteeism and short-term or long-term disability costs.
An estimated
40% OF PATIENTStaking medications
for a chronic condition are
non-adherent.1
Medication non-adherence costs
the Canadian health care system
approximately
$4 BILLION
each year and results in
5% of all hospital
admissions and physician visits.2
So what leads to medication non-adherence? Here’s what patients often say:
1 Express Scripts Canada Drug Trends Report 20132 9000 Points of Care: Improving access to affordable healthcare, April 2013
A patient’s lack of understanding of their condition can also lead to non-adherence.
For example, high blood pressure is referred to as the ‘silent killer’ because there aren’t many symptoms. Since there’s no immediate impact on their well-being and the long-term benefits aren’t understood, patients may not take their medication as prescribed.
Lack of communication between a patient and their health care provider can also contribute. Some people are uncomfortable discussing concerns such as side-effects with their physician or pharmacist, so they stop taking their medication. Or they don’t have a dedicated health professional to provide follow-up care.
In light of this growing trend, we’re dedicated to providing you and your plan members with tools and solutions to help support medication adherence and minimize both health and financial risks.
Online resources – Health eLinks and My drug plan help plan members educate themselves about their medical condition, the drug prescribed, if there is a lower cost alternative, and the estimated out-of-pocket cost prior to purchasing the drug.
Partnerships – Our partnerships with innovative leaders like Express Scripts® Canada and Bayshore HealthCare Ltd., give plan members access to health care professionals who will play an active role in encouraging adherence.
We can help you address the non-adherence trend: look for more solutions from Manulife.
Biologic medications have revolutionized the treatment of many complex diseases like cancer, multiple sclerosis and rheumatoid arthritis. But their high price tag and rapid uptake have raised concerns for many private plans.
Subsequent Entry Biologics definedUnlike generic drugs, which are considered equivalent to brand-name drugs, Subsequent Entry Biologics (SEBs) are considered similar, but not identical to the original biologic. This means SEBs are required to go through a more rigorous approval process than traditional generic medications.
Where are we on the SEB front? Experience with SEBs is limited in Canada. Omnitrope™, a growth hormone, was the first SEB to be sold in Canada. In 2014, two SEB versions of Remicade® (infliximab) – used in the treatment of inflammatory conditions such as psoriasis and rheumatoid arthritis – were approved by Health Canada.
Health Canada recommends against the interchangeability of SEBs with the originator biologic. The final decision on interchangeability, though, ultimately lies with each province. Quebec is now limiting the reimbursement of Remicade to the cost of Inflectra™, the SEB version, when used for certain indications. Other provinces have yet to take similar action.
Hope on the horizon?As patents protecting biologic medications continue to expire, more SEBs are expected with versions of Enbrel® (etanercept), Humira® (adalimumab), Lantus® (insulin glargine) and Neupogen® (filgrastim) in development.
And while the introduction of SEBs has the potential to positively impact drug plan costs, unknown factors make it difficult to determine the exact impact, including:
■ How will SEBs be priced in relation to the original biologic? Inflectra is priced roughly 30 per cent less than Remicade. Will this cost difference hold true for other SEBs?
■ Will SEB manufacturers find it difficult to launch these products in the highly competitive Canadian pharmaceutical market? Despite obtaining Health Canada approval, the manufacturer of Remsima™, the other infliximab SEB, has decided not to market the product in Canada.
■ How will physicians react to these new products? Will they embrace SEBs or will they continue to prescribe the name brands?
■ How will pharmaceutical manufacturers respond? Will the introduction of SEBs make them more willing to reduce the price of their products?
We’re keeping a close eye on these developments and are in discussions with key stakeholders, such as physicians, patients and pharmaceutical manufacturers. Manulife is committed to supporting the financial sustainability of drug plans and plan member health, and we believe that in the near future, SEBs will play a significant role in supporting both.
Remicade® is the top drug by drug spend and represented
4.69% of total
drug spend in 2014 (Manulife National Data, 2014)
Savings, services and improved health outcomes with Specialty Drug Care
n C O S T M A N A G E M E N T
Manulife’s Specialty Drug Care is designed to help improve plan members’ health outcomes and provide savings to both plan sponsors and members.
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Manulife’s new Specialty Drug Care program delivers a winning combination of savings and services.
Manulife’s Specialty Drug Care is a new program featuring a preferred pharmacy network, preferred pricing and case management services delivered in partnership with Bayshore HealthCare Ltd., one of the largest private healthcare companies in Canada. Bayshore operates in more than 100 locations, has a network of more than 11,000 healthcare professionals nationwide and delivers prescriptions and services to all provinces and territories within Canada.
Preferred pricingIn addition to the savings generated by quality case management, Manulife has negotiated a preferred dispensing fee, markup fee and markup fee limit to provide savings on high cost specialty drugs.
Program accessSpecialty Drug Care supports plan members with specialty drug prescriptions. Plan members with a new specialty drug prescription are introduced to the program through our prior authorization process. A designated nurse case manager will reach out to advise them of our prior authorization decision, explain the program, and arrange to have their medication dispensed.
Plan members already taking a specialty drug can call our Specialty Drug Care toll-free number to learn more about the program and enrol.
Easy to implementSpecialty Drug Care is available to plans with a drug card and there’s absolutely no cost to introduce the program to your benefits plan. While
contacting plan members with a new specialty drug prescription encourages participation in the program, we’ll also provide you with communications support to help you promote Specialty Drug Care.
And there’s still more to come! We’ll be introducing new features in the near future to make it easier for you to encourage plan members to participate.
Note about QuebecRegulations in Quebec currently prevent us from offering a preferred provider network in this province, but we are pleased to offer plan sponsors, with employees in Quebec, access to specialty drug case management. This is an optional program that can be made available. There is a fee associated with this service.
The value of Specialty Drug Care: ■ Savings on specialty drugs.
■ Specialty drug pharmacy services that offer choice on where and how medication is dispensed.
■ Improved health outcomes through best-in-class health case management.
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We’ve expanded our list of drugs requiring prior authorization so let’s expand your knowledge too.
What is prior authorization?Prior authorization is an effective claims-management feature applied to most drug plans. It helps control drug costs, while providing plan members with access to appropriate drug therapy.
Why does Manulife require prior authorization?It allows us to gather the information required to validate if the drug is being prescribed for its intended use and meets the eligibility criteria of your drug plan.
What drugs are on Manulife’s prior authorization list?The list is updated as needed, but it generally includes drugs that:
■ May be eligible for payment under a government program
■ May be used for experimental or investigational indications
■ Can also be prescribed for cosmetic use
■ Are approved by Health Canada for specific medical conditions
■ Are part of a therapeutic class excluded by your plan
■ Have less expensive alternatives that should be tried first
■ Require reassessment after a trial period
•
Prior authorization is a cost savings tool for you and your plan members. By expanding our drug list, everyone wins – all without compromising appropriate drug therapy.
n C O S T M A N A G E M E N T
EXPANDINGyour knowledge of prior authorization
10
Many drugs requiring prior authorization are high cost specialty drugs used to treat complex chronic and life threatening conditions.
11
Express Scripts® CanadaCanada’s Home Delivery program – the active pharmacy difference.
Managing drug plan costs without impeding access to drugs can be a tricky business, and more and more plan sponsors are looking for pharmacy partners to play a stronger role to help manage these costs.
Potential for reducing costs can be found in maintenance medications – drugs that are taken on a regular basis to treat conditions such as asthma, diabetes, high blood pressure and high cholesterol. Once stable, these drugs can be dispensed every 90 days.
When it comes to maintenance drugs, Express Scripts Canada’s (ESC) Home Delivery program offers one of the most comprehensive pharmacy solutions to help manage costs associated with these types of drugs.
By combining elements of adjudication with pharmacy best practices, ESC Home Delivery can help encourage plan member participation and deliver savings for you and your plan members.
ESC Home Delivery offers the services of a fully accredited, licensed pharmacy, as well as member communication and engagement support, competitive pricing, 24/7 access to a pharmacist and home delivery all at no additional charge.
The program is supported by pharmacists who take action to help deliver savings by:
■ Dispensing the medication at optimal intervals – shorter day supply until the patient is stable, longer day supply for ongoing maintenance.
Maintenance medications are taken on a regular basis to treat conditions such as asthma, high blood pressure, high cholesterol and diabetes.
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■ Maximizing the use of generics.
■ Monitoring timing of refills to ensure that the day supply on hand is optimal.
■ Refilling before the member runs out – improving member adherence and reducing the chance that a condition worsens.
Increasing plan member participationTo help increase member participation, ESC has developed adjudication controls to help plan members be aware of the program, but more importantly, to make a conscious decision to participate or not participate in the program. By requiring plan members to make a decision, ESC Home Delivery applies some of the fundamentals of Health Decision ScienceTM, increasing the likelihood of a plan member participating in the program.
Now in QuebecHome Delivery is now available in the province of Quebec, through PharmaGO.
Although the program has been adapted to ensure compliance with provincial regulations, pharmacist- owners under the PharmaGO banner will offer services to plan members in the province of Quebec to help deliver savings.
Save atA lot of us like to shop at Costco and save on everything from cereal to televisions. But did you know Costco Wholesale Pharmacy offers the same medications as other retail pharmacies at extremely competitive prices?
We can help you set up Costco as a preferred provider network so you can encourage your plan members to take advantage of these savings. You do not need to be a member to shop at the pharmacy, but you do need a membership to purchase items other than prescription medications. And like other pharmacies, Costco pharmacists provide counselling and advice on how to take the medication.
Be sure to check out their Health and Wellness Clinics at www.costcopharmacy.ca
1 Express Scripts Canada, 2014
Delivering more than just convenienceWhile home delivery can be convenient for plan members, early adopters of the program experienced, on average, a 10 per cent reduction in maintenance drug spend and a 20 per cent increase in medication adherence in the areas of diabetes, hypertension and cholesterol.1
High member engagement, plan savings, and improved health outcomes – ESC Home Delivery can provide more than just convenience for your plan members.
10%20%
Early adopters of this program experienced, on average, a
reduction in maintenance drug costs, and an increase in medication adherence for diabetes, hypertension and cholesterol.1
® Registered trademark of Price Costco International, Inc. used under license.
13
Setting limits on pharmacy fees is a common approach that provincial drug plans, pharmacy benefit managers and insurers apply to protect you and plan members from excessive charges.
Pharmacies in Quebec, as in other provinces, can set their own drug markups and dispensing fees. Without controls in place to manage these costs, there’s potential for inconsistent pricing and for excessive costs to be passed on to plan members and sponsors. If left unchecked, drug benefit plans may cost more than they should.
Positive experience to dateSince implementing the new Reasonable and Customary (R&C) limits in Quebec in March 2014, we have monitored incoming calls from plan members to assess the impact. The great news is this change did not appear to introduce much, if any, disruption in the plan member experience. This could mean that pharmacies are charging within the new Manulife limits or have chosen to absorb the difference between their
costs and the R&C limits. In some cases pharmacies may have elected to charge their customers the excess fees, but savvy shoppers will shop elsewhere.
For those plan sponsors in Quebec still considering whether to apply the new R&C limits, client savings average out to be about one per cent, but more importantly, implementing limits would set a boundary for pharmacy pricing and provide protection for plans in the future.
Introducing R&C limits does not conflict with a drug plan being Régie de l’assurance maladie du Québec (RAMQ) compliant.
Keeping plan members informedInformation is available on manulife.ca/planmember to help plan members understand the need for cost controls, what the components are that make up the cost of a drug, as well as ways to reduce their medication costs.
Reasonable and Customary savings in QuebecLimits on pharmacy markups and dispensing fees help improve cost savings.
Through our partnership with Express Scripts Canada®, we’ve negotiated preferred pricing for Remicade®. As of spring 2015, the cost of Remicade will be reduced for all plan members in all provinces and territories, except Quebec, enrolled in a Manulife pay direct drug plan.
This preferred pricing arrangement doesn’t require physicians to change prescribing habits or plan members to change their current therapy. The discount will be administered at the pharmacy counter for members using their pay direct drug card.
Negotiating discounts for highly used medications is another way we add value to your drug plan.
Plan members in Quebec
Regulations in Quebec prohibit the manufacturers of drugs on the RAMQ Formulary to have exclusive agreements with a single payor.
A new partnership brings you greater value.
About Remicade
Remicade is used in the treatment of ankylosing spondylitis, Crohn’s disease, psoriasis, psoriatic arthritis, rheumatoid arthritis and ulcerative colitis.
Remicade is the number one ranked drug in terms of plan costs. In 2014, the average cost per claimant, according to Manulife data, was $24,000.
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n P L A N M E M B E R E X P E R I E N C E
Would it surprise you to know plan members don’t understand how their drug plan works? Its limitations? The options they have to reduce their costs? You’ll be surprised how My drug plan answers their questions – and more!
Imagine your plan members going to one place for answers, taking advantage of lower cost options and helping your bottom line. Yes, it’s possible.
My drug plan is a user-friendly online tool on the Manulife Plan Member Secure Site that provides members with coverage information about their drug plan. It’s easy to use and they can access information quickly using their computer/laptop or favourite mobile device. Perfect for those on the go – even when sitting in the doctor’s office.
Features:Our drug lookup tool helps members find out:
■ If their prescription is covered.
■ Their savings from choosing a lower cost alternative drug (typically the generic).
■ Whether or not the drug requires prior authorization.
In addition plan members can:
■ Access prior authorization forms.
■ Check for provincial programs that may provide coverage.
■ Link to our Step Therapy and dispensing fee limits resource centres (if applicable).
■ Search for information in the drug library – how best to administer a drug and any side-effects.
We’re excited to give any plan member with a drug card access to My drug plan – a tool to help answer all their questions and become better health care consumers.
My drug planComing soon! This tool does more than just answer your plan member’s questions.
MY DRUG PLAN IS PERFECT FOR PLAN MEMBERS ON THE GO!
n H E A L T H M A N A G E M E N T
The case for case managementManulife’s Specialty Drug Care can provide savings, but the heart of our program is case management.
Specialty drugs treat complex chronic and life threatening conditions. And while there is often no cure for many of these conditions, our Specialty Drug Care case management program can play a significant role in helping delay disease progression and improve the quality of life of plan members.
The full range of case management services includes: ■ Providing information and education about the condition and medication.
■ Helping members manage any side-effects that arise due to drug therapy.
■ Working with members to help ensure they’re taking the drugs as prescribed.
■ Health coaching – encouraging the plan member to take action and manage their own health risks, such as improving diet, exercise habits and smoking cessation.
■ Referring members to community based resources to support treatment (e.g., occupational therapist or physiotherapist).
■ Co-ordinating efficacy testing to help ensure drug therapy is working.
■ Ensuring that the plan member is leveraging resources available through drug manufacturer patient assistance programs.
Working directly with plan members can benefit you tooRegistered nurses, supported by pharmacists and pharmacy technicians, provide our case management services and help complement the circle of care plan members receive. Absenteeism and disability can often be the result for plan members who require specialty drugs to manage their condition. Intervening early to make sure they’re aware of self-management techniques can help reduce or avoid workplace disruption.
Motivational interviewing
A lot of us struggle with making lifestyle changes to improve our health and well-being. The same goes for those with a complex medical condition. That’s why health care professionals use motivational interviewing – a counselling technique which helps patients explore the differences between their current behaviours and personal health goals.
Our Specialty Drug Care case managers use motivational interviewing to assist with health coaching, medication adherence and adherence to other therapies such as exercises recommended through occupational or physiotherapy.
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n H E A L T H M A N A G E M E N T
Managing mental health in the workplaceAre you experiencing higher levels of absenteeism, lower productivity, reduced employee engagement and increasing disability and drug claims?
Discover Workplace Solutions for Mental HealthVisit manulife.ca/mentalhealth to discover tools to help you create a safe and healthy work environment. There are a lot of resources for plan members too, so we encourage you to share this site.
Short, informative videos for employers and employees.
Tips, tools and resources for employees and support for family and friends.
Tips, tools and resources for employers.
Quick access to popular articles and information.
Links to articles on our commitment to mental health, our strategic partnerships and news releases.
Featured articles and updates on mental health.
Immediate access to crisis centres, along with awareness and prevention resources.
Look for ‘Manager Training’ when you visit manulife.ca/mentalhealth
This interactive training program was developed in partnership with Homewood Human Solutions™, a recognized leader in providing prevention and intervention support in the field of Employee & Family Assistance, substance abuse, addiction and mental health.
Training provides managers with:
■ Knowledge to create a ‘mentally healthy workplace’.
■ Skills to respond confidently and proactively when they feel an employee’s psychological safety is at risk or they’re showing signs of mental illness.
500,000Canadians missed work today due to mental health issues.1
More than
30% of disability claims and
70% of disability costs are attributed to mental illness.2
&
Medications for the treatment of mental health conditions represented 8% of total drug plan spend in 2014 (Manulife Data)
Mental health in the workplace is a complicated issue for plan sponsors. We have specifically designed our drug programs like Manulife Managed Formulary, Step Therapy, and prior authorization, in such a way that they don’t limit or restrict access to mental health drug therapies. We understand that adding additional steps to access treatment for individuals suffering from a mental illness is not in the best interest of our plan sponsors. These individuals may have a compromised ability or desire to consider alternative therapies. Fortunately, improving how you manage mental health in the workplace can help protect your bottom line. Manulife is committed to providing plan sponsors with solutions to help you create a healthy work environment.
1 Mental Health Commission of Canada (MHCC) 2 Benefits Canada: Workplace mental health articles/resources
Health Risk Assessment (HRA) enhancementsNow it’s even easier to identify employee health risk factors and target your employee wellness programs.
We’ve updated the HRA tool:
■ Enhanced look and navigation.
■ New questions: - Disease history, medical screening/biometrics, and - Workplace Limitation Questions (WLQ) - to help
evaluate the cost of chronic disease on productivity and absenteeism.
■ Improved reporting to help easily identify key employee health risk factors and the costs associated with those risk factors.
We can provide you with promotional campaign support to encourage employees to complete the HRA. In return, you’ll get valuable insights into the health of your employee population and where best to invest your wellness program dollars.
HRA is part of our online health resource site, Health eLinks.
n H E A L T H M A N A G E M E N T
Total loss for all “at risk” employees: $105,002,529
“At risk” forN+5755 $ Total loss for
Presenteeism + Absenteeism*
Annual Productivity Loss total $ (million)
# %
Alcohol/Drinking Habits 1005 18 19,420,620
Cardiovascular Risk 2169 37 40,300,020
Coping with Stress 1609 28 29,599,164
Depression 628 11 11,565,248
Healthy Eating 77 1 1,272,964
Medical Screening 1005 18 19,420,620
Medication Management 2169 37 40,300,020
Physical Activity 2900 55 58,599,164
Smoking 628 11 11,565,248
Social Ties 77 1 1,272,964
Visiting your Doctor 1005 18 19,420,620
Work and Safety 2169 37 40,300,020
Your Sleep Health 1609 28 29,599,164
Your Weight 628 11 11,565,248
* Reported productivity losses for each category population are due to all factors affecting that population, not just the risk factor by which they have been grouped.
Express Scripts Canada, a registered business name of both ESI Canada and Express Scripts Canada Services, each an Ontario partnership is indirectly owned by Express Scripts, Inc. and is one of Canada’s leading providers of health benefits management services. From its corporate headquarters in Mississauga, Ontario, Express Scripts Canada provides a full range of integrated pharmacy benefit management (PBM) services to better facilitate the best possible health outcomes at the lowest possible cost. For more information about Express Scripts Canada, visit express-scripts.ca. Homewood Health is a recognized leader in the field of Employee Assistance, Organizational Wellness and Employee Health Management Services. The firm provides EFAP/EAP, crisis management, e-learning, health coaching, leadership development, psychological assessments, and other services in Canada and around the globe. Bayshore HealthCare Ltd. is one of the country’s leading providers of home and community health care services and a Canadian-owned company. Its services are purchased by government care programs, insurance companies, workers’ compensation boards, health care organizations, the corporate sector and the public. The Bayshore brand extends across four business divisions: Bayshore Home Health (medical and non-medical home care and staffing services), Bayshore Specialty Rx (specialty pharmacy, infusion and pharmaceutical patient support services), Bayshore Therapy & Rehab (physiotherapy and rehabilitation services) and Bayshore Dialysis (dialysis centers). The company’s goal is to enhance the quality of life, well-being, dignity and independence of Canadians of all ages. Bayshore HealthCare has been a recipient of Canada’s Best Managed Companies award since 2006. For more information, call 1-877-289-3997 or visit bayshore.ca.
Manulife, the Block Design, the Four Cube Design, and Strong Reliable Trustworthy Forward-thinking are trademarks of The Manufacturers Life Insurance Company and are used by it, and by its affiliates under licence.GC2537E 03/15
Claims Management at a glance
LEVERS TO CONTROLLING COSTS
Effective claims management can be complex and requires that a number of safeguards are in place to help make
sure plan sponsors gain value from their drug plan. To help manage costs, Manulife offers a full array of coverage
options, coupled with claims administration management and controls.
Claims AdministrationStandard claims management features with all Manulife pay-direct drug plans.
Plan DesignPrograms and features available at Manulife Group Benefits.
Drug coverage Claims controls Cost sharing Distribution focus
■ Coordination of Benefits (COB)
■ Drug Utilization Review (DUR)
■ Dynamic Maintenance
■ Enhanced Provincial Integration
■ Hospital program
■ Prior Authorization – Enhanced Prior Authorization program to target specialty medications
■ Reasonable and Customary (R & C) in all provinces – Drug price files – Dispensing fee thresholds – Mark-up fee thresholds – Dollar limit on mark-up
■ Product Listing Agreements (PLAs)
■ Pharmacy Agreements
■ Risk management – Same day and onsite audits – Data profiling – member and pharmacy
– Narcotics risk profiling and management
■ Standard formularies – Prescribed plan – Prescription plan – Provincial plan
