The most appropriate and cost effective treatment
Just 20% of claimants represent 80% of plan drug spend—and their drug costs are 15 times greater than the rest.* Our built in prior authorization drug program, which includes step therapy and special authorization, is another way to effectively curb spending.
By requiring some medications to be pre-approved for coverage, we help make sure employees receive the most appropriate and cost effective treatment:
- Employees take clinically proven, less costly first line drugs before more expensive treatments
- Off-label treatments are avoided and employees are only covered for drugs Health Canada has approved for their medical condition
- Provincial health plans or patient assistance plans pay the cost of certain drugs, wherever possible
By requiring some medications to be pre-approved, we help make sure employees receive the most appropriate and cost effective treatment
* Express Scripts Canada Prescription Drug Trend Report, 2018