Manulife Launches DrugWatch

September 22nd, 2015

The prescription drug landscape in Canada continues to change rapidly and each of the Canadian insurers have been taking different approaches to help plan sponsors manage the current and emerging cost of recent drug therapies in the marketplace. Some of these drugs are intended for large populations that may have a significant impact on an organization’s health benefits spend.

For example, Repatha, a new drug used to treat high cholesterol, can cost as much as $7,300 per patient per year – that’s 80 times the cost of Crestor, the generic drug many patients currently use.

Manulife asks the question: In theory, paying more to get better health outcomes isn’t unreasonable. However, when it comes to private plans, do new, more expensive drugs generate sufficient additional health outcomes to justify the higher cost?


Manulife DrugWatch

Given the concerns of some of these drugs coming to market, Manulife has launched DrugWatch, a rigorous oversight program designed to ensure plan sponsors are getting value for the dollars they spend on these new drugs. DrugWatch will provide:

  • A critical eye on emerging drugs – Manulife stays on top of newly-approved medications and newly-approved uses by Health Canada. Drugs expected to impose a considerable financial cost on drug plans will be placed On Watch and subjected to further review before they can be considered for addition to your clients’ plans.
  • A reliable, third-party review – Manulife will determine the value of new drugs coming to market based in part on the publicly available information from the Canadian Agency for Drugs and Technologies in Health (CADTH). CADTH reviews drugs and makes reimbursement recommendations to Canada's federal, provincial and territorial public drug plans, with the exception of Quebec, to guide their drug funding decisions.
  • A rigorous process to help ensure new drugs can be offered efficiently and at the right value for the money. Informed by CADTH recommendations, Manulife will work with pharmaceutical manufacturers to seek the best possible drug prices and determine if an effective delivery program, such as an adherence plan or an exclusive distribution arrangement, can help provide additional value.

The DrugWatch program is currently applicable to all Manulife drug plans.

Standard Life contracts require an amendment to support this program. We want these clients to be able to experience the benefits of Manulife DrugWatch as soon as possible so we will send a mass amendment to all Standard Life plan sponsors shortly. These sponsors will be asked to provide written approval to Manulife in order get access to Manulife DrugWatch.

In the meantime, we will depend on Standard Life’s prior authorization program to help manage the impact of higher cost drugs coming to the market.


DrugWatch Considerations for Plan Sponsors

Below are some of the considerations that plan sponsors should keep in mind as they decide on whether to accept the changes or opt-out of the DrugWatch program:

  • DrugWatch implementation will force a formulary on all plans that participate
  • There will be a determination period for drugs under review that may affect the availability for those drugs to be covered possibly leading to a change in the employee experience at point of sale
  • Organizations with unionized populations covered under a collective bargaining agreement will need to discuss the implementation with their unions to ensure the DrugWatch program is not considered a change to the collective bargaining terms
  • Plan Sponsors that decide to opt-out of the program will need to consider the potential risks and possible pricing changes associated

A brochure providing further information of the Manulife DrugWatch program is included below.

Category: Insurance Insights