RAC012_10.15

RWAM INSURANCE ADMINISTRATORS INC. www.rwam.com

COMMUNICATIONadvisor

October 2015

RWAM & Green Shield Canada (GSC) launch new Preferred Pharmacy Network (PPN) for Specialty Drugs

The specialty drug PPN is included for all RWAM groups who utilize GSC as their pharmacy benefit manager.

Effective September 2015, Green Shield Canada (GSC) has introduced a preferred pharmacy network (PPN) for specialty drugs.

While undoubtedly improving plan members’ lives, high-cost specialty drugs pose a significant financial challenge for Canada‘s private and public drug plans. GSC’s specialty drug PPN will limit the financial impact of these high-cost specialty drugs on your client’s plan and ensure that plan members taking these drugs receive the treatment support they need. To deliver the specialty drug PPN, GSC has partnered with HealthForward, a subsidiary of AmerisourceBergen Canada, an industry leader with extensive specialty medication experience.

GSC’s cross-Canada specialty pharmacy network includes many familiar chain pharmacies such as: Shoppers Drug Mart, Loblaws, Safeway, Lawtons Drugs, Sobeys, along with a few independents, mostly in rural/remote areas. Approximately 100 drugs (or 250 unique DINs) that treat a range of illnesses such as rheumatoid arthritis, multiple sclerosis (MS) and hepatitis C are included in the PPN.

All drugs included in the PPN require prior authorization from GSC before a claim can be reimbursed. Once the new claim is approved, plan members are automatically enrolled in the program, and will be contacted by a care coordinator at HealthForward. Care coordinators provide personalized support, with a focus on adherence, coordinating any applicable patient assistance programs, and helping plan members find a participating network pharmacy in their community. Plan members must obtain applicable specialty drugs from a participating network pharmacy to receive reimbursement under their drug plan. Specialty drugs purchased through a non-participating pharmacy are not eligible for reimbursement.

Participating network pharmacies have agreed to reduce their pharmacy mark-up for the specialty drugs included in the PPN, reducing overall drug plan costs and any applicable out-of-pocket costs for plan members. For some drugs, plan members will be offered coordination with patient assistance programs which may further reduce their out-of-pocket costs.

GSC has sent letters to plan members who are currently taking any of the specialty drugs included in the PPN. The member will be advised if a pharmacy change is required for continued reimbursement of these claims, and provided information on how to contact HealthForward to enrol in the PPN support program.

For any new specialty drug prescriptions, plan members can find out whether their specialty drug is included on the PPN by calling RWAM’s Customer Service Centre.

Please contact your RWAM Marketing Manager if you have any questions.