SM Blog: » see older posts
- Sunday March 11, 2012
-
The Winnipeg Art Gallery Presents...
American Chronicles: The Art of Norman Rockwell March 2, 2012 to May 20, 2012 - » Read More
- Sunday March 11, 2012
-
National Exposure
In addition to speaking on current benefit trends at the HRPA in Toronto last month, Kevin and I were both published in National industry magazines... - » Read More
- Thursday March 1, 2012
-
Jets Make a Big Splash at DU Ministers Dinner
Shane Hnidy (TSN - Retired Boston Bruin), Dustin Byfuglien and Zach Bogosian support Ducks Unlimited and the Oak Hammock March Interpretive Centre - » Read More
SM Benefits & Pensions:
Enhanced Prior Authorizations
Posted by: Angela Jorowski
In Mike Sullivan’s recent Benefits Canada article; (http://www.benefitscanada.com/benefits/health-benefits/protect-your-drug-plans-with-enhanced-pas-18451) he correctly advises plan sponsors to protect their benefit plans by implementing an enhanced Prior Authorization process for non-standard coverage requests.
This is due to the fact that in today’s world plan members have unprecedented access to drug information and alternate treatment options - literally at their finger tips. Requests to provide coverage for alternate therapies is starting to put significant pressure on employer plans, especially those that do not have established criteria for coverage.
It is great to see members so much more educated about their conditions and treatment options, however members don’t always have the ability to interpret and gather all the relevant clinical information. As a result, we are more commonly seeing cases where members are pushing the envelope and moving into the realm of experimental, even with drugs already on the market and indicated for other uses.
Adding pressure to the situation, these patients are often supported by their physician(s) in their bid to have the employer-sponsored plan cover these therapies given that the provincial programs often will not support any alternate treatment regimen.
Plan sponsors need to realize how significant a threat to cost containment this new era of patient empowerment is. These extra costs are very material to plan sponsors, and while the employer would like to be in a position to assist all of its plan members however they can – there are always limits to what they can do.
So, it is time to get serious about implementing enhanced Prior Authorization programs with meaningful approval criteria to ensure that only those who are likely to benefit from a therapy have access to it. Otherwise employers may be forced info investing significant financial resources into areas where there is very little (if any) evidence of efficacy, and this could threaten the long-term sustainability of the plan for all members.
How do you establish a Prior Authorization process with meaningful criteria? Ask your advisor, and ensure your plan is protected.