Friday, Oct 2, 2015
Highlights from our first Advisor Forum
By Helen Stevenson
Drug PlanDrug Plan Community
We – Reformulary Group – hosted our first Advisor Forum on Tuesday September 29 at the Donalda Club. We are so grateful to all of the attendees for being such an attentive and interactive audience! We are excited to interact more and continue to provide resources and tools that help advisors bring our solution to clients. Below are a few highlights from the Forum: 

  • We hear often that the sustainability of private drug plans is threatened by the prevalence of chronic disease. Drug costs are becoming unmanageable, with an increasing number of specialty medications costing tens of thousands of dollars per treatment. A proven key to sustainable drug coverage is managing your drug plan’s formulary (or list of drugs covered).
  • Insurance carriers typically charge a percentage of drug spend as a pooling charge to share the financial risk of large claims. If you haven’t already seen pooling costs increase by 30-50%, you may well as insurers adjust pooling costs to make sure money in (premiums and pooling costs) is greater than money out (claims).
  • Introducing drug plan management into union groups provides an opportunity for shared savings – but start to tell the story early and be flexible to new and emerging solutions!
  • Spending on medical cannabis is mostly 100% out-of-pocket and increasing as doctors get more comfortable prescribing this unique treatment.
To note: Our MobilPoints were great!! We had fantastic engagement on these nifty smartphone tap points at each table created by our friends at RadiantGroup. A number of advisors have asked for more information about this product – read about them and request a demo here.

Please feel free to share the presentation decks and some of our other great resources with your team: Here.

Wednesday, Mar 25, 2015
Patients: The Newly Engaged Consumer
By Helen Stevenson
Drug PlanDrugFinderWebsite

Reformulary Group is encouraging a new healthcare trend that is making waves throughout the system. Although this trend extends past private drug plans, they do not stand alone. In fact, we feel that they are at the very heart of this growing movement. You might be surprised by the simplicity of this idea but with momentum it has the ability to truly transform the way healthcare services are provided. So what is this trend? Consumer engagement, and positioning consumers (patients) at the epicentre of our healthcare universe.

Health Minister Dr Eric Hoskins spoke recently about this trend and its importance to the healthcare system in Ontario. "Doing a better job in health care means understanding and predicting the needs of Ontarians." Hoskins spoke further about the first action plan, Patients First, which "recognizes that the health system belongs to patients," and that "it is shaped by their experiences, and seeks to empower them." Read more about the Patients First plan here.

Consumer - and patient - empowerment is where we find ourselves best aligned with this theme. That said, putting consumers first can only improve the system if they themselves accept this role and engage themselves in their healthcare decisions, including the most effective use of prescription drugs.

Toby Cosgrove, CEO of the Cleveland Clinic, emphasized this point in a recent Huffington Post article, "the patient has to become part of the team". Regarding patient results he states' "It's your chart and you better understand what's going on."

We believe the same must apply to drug plans in the private sector: It is your drug plan and you better understand what is covered. Equally so, employers are spending significant amounts of money on highly specialized treatments without fully understanding the value they are providing - or not providing- to their employees. Meanwhile, these employees have become active consumers in their drug plans and not only do they want transparency, they want choices. 

Reformulary has addressed this need by empowering consumers to become engaged consumers through our online tool, DrugFinder. This tool guides plan members through their drug plan, providing an understanding of what drugs provide the highest value and what similarly effective alternatives exist. With more than 110,000 members in Canada under drug plans powered by Reformulary, this tool has become a vehicle to put patients first and encourage their engagement in the world of prescription drugs.

So, what’s your take on the impact of plan member/patient engagement in private drug plans? Tweet  using #EmployeeEngagement and #DrugFinder.
Wednesday, Feb 25, 2015
With hep C, no private drug plan is an island
By Helen Stevenson
Drug PlanHep C
Prince Edward Island recently announced  plans to fund an expensive new drug treatment for people suffering from hepatitis C (HCV).

Is it rumored that this is the first time a Canadian province has funded a class of medication priced this high, to treat a patient population this large.

And while it is very important to provide the best possible treatment for every patient who needs it, the question arises: is it affordable?

Specialty drugs target hep C, at a price

Like all specialty drugs, hep C drugs come with a hefty price tag — about $60,000 according to André Picard’s recent editorial in The Globe and Mail. This price sends “shivers down the spines of finance ministers from coast to coast to coast, especially when they consider that there are an estimated 242,500 Canadians living with hepatitis C”.

Employer-sponsored drug plan managers are already starting to feel the pinch too.

Baby boomers — many of them enjoying private drug plan benefits — happen to be Canada’s hardest hit demographic with hepatitis C.  I know one employer who recently saw a 9,000 per cent increase in drug spend on hep C drugs alone. Another plan experienced a 1,400 per cent increase. The culprit? The new hep C drugs.

Fix 1: Maximize buying power, minimize drug spend

Key to a more sustainable drug plan is negotiating the best possible drug prices. In his editorial, Picard wonders why “PEI would go it alone in price negotiations” with AbbieVie Canada, the manufacturer of a hepatitis C specialty drug.

Picard is right. It’s simple economics. The more you expand your buying power, the better the pricing — and the same holds true for private drug plans.

Reformulary has buying power: over 110,000 Canadians have their drug plans powered by Reformulary. As more people subscribe, our buying power with pharmaceutical companies gets even stronger. That, combined with a better managed plan, has delivered spectacular results:

-          Reformulary has saved employers between 8% to 15% on total drug spend over the last two years.

-          All drug plans powered by Reformulary have reported an ROI between 200% to 2,000%.

Fix 2: Answer multi-billion dollar questions

Picard notes that provinces simply cannot afford to provide all Canadian HCV carriers with treatment. Picard states the “multi-billion dollar questions” provinces must ask: who is eligible for hepatitis C treatment, who isn’t and why.

If you’re a private drug plan manager, you should ask yourself these very same questions. And Reformulary is here to help:

-          Our independent expert committee of doctors and pharmacists meets regularly to review the thousands of drugs covered by our drug plan.

-          Our drug committee analyzes current clinical and cost-effectiveness evidence, and real world experiences.

-          Our experts identify which drugs on the Reformulary provide the best healthcare value and are offered to members at the lowest co-pay.

-          Our committee also reviews new-to-market specialty drugs to ensure that these drugs are covered based on clinical guidelines.

So, what’s your take on hep C and drug plan sustainability? How can we help? Tweet using #reformHEPc.
Monday, Feb 9, 2015
Reformulary: A Better Managed Plan
By Helen Stevenson
Drug PlanDrug Plan CommunityDrugFinderSun LifeThe Co-OperatorsWebsite
After a recent conversation with Alan Cassels, I stumbled upon his, and Sean O'Brady's, excellent article, “Why Do Canadian Employers Waste $5 billion a Year on Inefficient Drug Coverage?”(Huffington Post). The article mentions that it’s time to seriously consider what can be done to reform drug coverage and eliminate waste. There IS one program available that is being used by 110,000 Canadians to get better value out of their drug plans. It’s called the Reformulary (

Here are some of the reasons that employers have chosen Reformulary to power their drug plans.

-          Value for money: The Reformulary uses tiers and co-pays to promote drugs that provide the best healthcare value (striking the balance between therapeutic value and cost effectiveness)

-          Savings: It works! Well-managed, the Reformulary has delivered unprecedented savings to employers (from 9% to 15% per member drug spend!) – And employees have benefited as well. Some employers have reinvested the savings by improving other benefits

-          Engagement: The Reformulary gives employees the information needed to make informed choices about the drugs they take.

-          Cost-effectiveness: On your behalf, Reformulary negotiates with pharmaceutical companies to promote drugs that are both clinically effective AND cost-effective.

-          Education: The Reformulary educates employees and employers about their drug plan. When your drug plan is powered by Reformulary, you can access the DrugFinder online tool to find out what exactly what drugs are covered by your plan, along with your co-pay options and clinical conditions (like quantity limits). Nobody is kept in the dark!

Shout out to our partners – Sun Life and The Co-operators – who have taken an innovative approach to help improve efficiency in the system.  

We’ve recently published a white paper on drug plan reform. It’s called "How better managed drug plans that engage employees are the way to a sustainable future". You can access it here
Friday, Jan 9, 2015
Welcome to our new website!
By Helen Stevenson
Drug PlanDrug Plan CommunityDrugFinderWebsite

Redesigned provides instant access, expanded capabilities, increased connection

We are excited to announce the release of our newly redesigned website. It has been crafted to reflect what you, our Reformulary community, told us you need— and also builds upon technology capable of addressing future needs.

We see our site as a gathering place for the drug plan management community, with expanded capabilities for learning, sharing and interaction. You'll notice streamlined menus, simple navigation and access to the information you need. We've designed the new Reformulary website to be your resource hub. 
Read more