On October 3, 2021, Canadians participated in the Run for the Cure and raised over 9 million CAD.
While we don’t yet have a cure for cancer, we’re making great progress when it comes to treatment. But some cancer drugs are very expensive. The Specialty Drug Program helps employees manage their health conditions, while more effectively managing costs.
October is breast cancer awareness month. October 12 is World Arthritis Day.
Specialty drugs are used to treat complex health conditions such as rheumatoid arthritis and cancer. They can help reduce the need for medical care and sick leave, and may increase productivity. But treatment can be confusing, especially given that employees are usually juggling several other drugs at the same time. And their high cost can overburden customers’ drug plans.
Comprehensive support for employees
The Express Scripts Canada Pharmacy team uses their expertise and active pharmacy approach to:
- Source treatment funding and support—Express Scripts Canada checks to see if a patient assistance program or provincial plan can cover the cost of the drug. They also navigate the process for employees, to make it easier.
- Review all medications—not just specialty drugs. Since employees are often taking several maintenance drugs—often from different doctors—Express Scripts Canada checks to make sure there is no duplication of treatment or drug efficacy issues. They can also coordinate refills so drugs arrive together
- Develop a comprehensive health action plan to address the employee’s health condition, medication, and education needs
- Provide proactive outreach to monitor employee’s progress and provide support and education about health conditions, medications, side effects, and drug treatment adherence.
- Send refill reminders so employees avoid treatment interruption
- Deliver medication safely, conveniently, and at no cost to the preferred location. This includes perfusion clinics, doctors’ offices, or home
- Make referrals to psychosocial supports where needed
- Act as the employee’s advocate—reaching out to doctors (with employee’s consent) to discuss side effects and/or changes in employee’s health condition
Specialty pharmacy: the heart of the program
Not all pharmacies carry specialty drugs. Because Express Scripts Canada is a specialty pharmacy they are able to dispense all specialty drugs— and employees get an enhanced level of care they may not receive at other retail pharmacies. That’s because not all pharmacies that dispense specialty drugs have the depth of expertise to provide robust support.
Value for customers
Positive influence on drug spending
Our specialty drug program1 is automatically included—which makes us different than most plans—and it’s a primary driver for why we have one of the lowest benefit cost trends in the market. That’s because cost management happens automatically:
- All specialty drugs are covered, so a greater number of employees receive a managed care approach. Some carriers include a limited number of drugs.
- $150 markup cap saves hundreds of dollars—even thousands—on every prescription
- Duplicated treatments are identified and eliminated
- Integration with provincial plans and drug company plans
- Adherence support helps avoid costly and unnecessary complications
Value for employees
There are distinct advantages to having the Express Scripts Canada Pharmacy as part of employees’ care management team:
Expert guidance and support can reduce stress associated with:
- Administering complex drugs
- Dealing with side effects
- Staying on track with multiple medications
- Disease management
- Safe and convenient delivery of drugs
- Lower out-of-pocket costs if coinsurance is less than 100%
1 * Does not apply to residents of Quebec or groups without a pay direct drug card
