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Industry strikes deal to protect drug plans from impact of high cost drugs

By Alain Thériault | April 17 2012 04:06PM

In early April, Canadian insurers announced a deal to collectively protect fully insured private drug plans from the full financial impact of high cost drugs. This agreement is aimed at helping ensure that Canadians with fully insured employer drug benefit plans can access the drugs they need. This is expected to be especially beneficial to SMEs.

A Leger Marketing poll conducted on behalf of the Canadian Life and Health Insurance Association (CLHIA) showed that a third of small and medium sized businesses would consider making changes to their drug plans if premiums were to jump in price by 25 per cent.

"It is the industry's view that no Canadian should face the prospect of losing their drug coverage due to rare but very expensive drugs costs…,” stated Frank Swedlove, president of the CLHIA in a news release announcing the initiative.

Prescription drug coverage in Canada is currently a mix of public and private accountability. In the absence of progress on a catastrophic drug program in Canada, insurers are banding together in order to share the costs of highly expensive and recurring drug treatments through an industry drug pooling framework, explained the CLHIA.

Going forward, participating insurers will set premiums for fully insured employer drug plans without including any pooled high cost drug claims. This will effectively shelter Canadians from potentially losing their employer-sponsored drug coverage due to a high cost claim – something that was increasingly a risk for those employed by SMEs. Twenty-three insurance companies across Canada, that collectively represent 100 per cent of the supplementary drug market, have committed to joining this pooling framework.

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