In the business of prescription benefit management, we tend to talk a lot about numbers and statistics. We use expressions like “drug trend” and “total plan spending” to express what we do. The reason is simple: We are keenly aware of the fact that the current and projected cost of comprehensive prescription drug benefits is not sustainable. And what we do every minute of every day is work with employers and their insurance companies to curb and manage those costs.
What is sometimes lost is the reason that the numbers matter so much. Yes, in the day-to-day, it is about bottom lines, but in the grand sense, it is about Canadians’ health, it is about employers’ commitment to their employees and it is about employers’ ability to continue to provide them a comprehensive prescription drug benefit.
One important way that Express Scripts Canada is helping make prescription drug plans sustainable today and tomorrow is our active pharmacy service, part of the Express Scripts Canada Active Pharmacy program, which is offered to employers that are concerned about the rising costs of their employee benefit plans and are looking for answers. We offer their employees an opportunity for better health outcomes at a lower cost.
The service goes far beyond what traditional pharmacies can deliver. You don’t just drop your prescription off. You are a member. Every new member, when they sign up for the service, gets a call from a member of the Express Scripts Canada pharmacy team to go over their various medications, recommend improvements and answer any questions. This is not just if someone complains or runs into problems. We consider it an essential part of a good pharmacy program, it ensures that we address concerns up front, and it minimizes the potential for problems in the future.
With many patients seeing multiple doctors for a number of different conditions, it is not at all uncommon to find that a patient is taking two medications for the same thing, or two that don’t work well together. With the patient's consent, we access their claims data, which provides a comprehensive history of their prescriptions, to verify medications, improve medication adherence and deliver other beneficial services.
By proposing changes to a patient’s care, we help them avoid potentially dangerous drug interactions, reduce duplication of medications, and ensure the best possible combination of medications for their various conditions. This is what our dedicated team of pharmacists does every day, simply to help our pharmacy patients receive the best care.
If a member has a question, or in very rare cases when there is a problem with their medications, we have a highly skilled team of pharmacy professionals at our Member Contact Centre, available by phone or email. And if there is an emergency after hours there is always a pharmacist on-call, 24 hours a day, 7 days a week.
Of course any pharmacy service is only as good as the information it receives, so we believe in double and triple-checking, with patients, and with their physicians if necessary, to make sure personal information, health information, dosages etc. are correct. Multiple verification steps executed by trained health care professionals have been built into our process to ensure patient safety.
Lastly, on top of our “standard” service, in complex cases where a patient is taking multiple medications from multiple doctors and/or where medications are changing, we take great pains to interact even more frequently with that patient to ensure their health and wellbeing. Not all patients appreciate the extra time on the phone, but we believe it is worth it to make sure our patients get the best care possible. This approach has sometimes revealed medication issues that were previously unknown to the patient and their doctor.
The lower cost is critical to sustainability, but “better health outcomes” is our mantra. We are able to deliver lower cost almost as a by-product of delivering better care. Delivery to any address of your choosing, online prescription management, auto-refill options and proactive reminders when prescriptions are coming up for renewal make it much less likely that patients will be left with gaps in their medication supply. When dealing with chronic conditions like diabetes, depression, high blood pressure and high cholesterol, minimizing those gaps is critical to a patient’s overall health.
In order to maximize savings and safeguard their employees’ drug benefits for the future, many employers offer financial incentives to use the Express Scripts Canada Pharmacy for maintenance medications, but it’s important to note that every patient ultimately has the choice to fill their prescriptions wherever they want.
And because the best health care is the goal, we want you to have ready access to your medications when you need them. That’s why we’ve built so many features into our service that encourage healthy behaviours. In addition, if your doctor prescribes a medication that needs to be taken right away, such as an antibiotic, we recommend you get it right away from whichever pharmacy is most convenient at the time.
When employers make the decision to benefit from the Express Scripts Canada Active Pharmacy program, they invariably do so because they care about their employees and they know that they can’t continue to offer comprehensive prescription drug benefits without a change. When they introduce the program to their employees, of course there is some resistance to change, but we find that a large majority are highly satisfied after using the service for a while.
Employees that don’t find deliveries to their home convenient (e.g., they are on the road) can request delivery to any location that they choose. Whatever the issue, they have 24/7 access to an experienced pharmacist.
Ultimately, with very few exceptions, the active pharmacy is simply a better pharmacy service for members. Not just in terms of cost. In terms of service, in terms of keeping patients informed, and in terms of encouraging healthy behaviours. In a world of rapidly escalating cost, it is a great way to keep comprehensive prescription drug benefits sustainable today, and tomorrow.
Michael G. Biskey is President, Express Scripts Canada