Control Your Costs

What can plan sponsors do?

Thanks to the AGA +PLUS program, many measures are available to help plan administrators control drug costs. Applying all these measures can generate recurring savings of 5% to 10% of drug claim costs.

Many apply automatically, others on request. Here are the key measures available:

• Biosimilar drugs: Requirement to use biosimilar drugs;
• Generic substitution: Reimbursement based on the cost of the lowest-cost generic equivalent;
• Prior authorization program: Requirement for additional medical information for certain drugs to be pre-approved;
• Step therapy: Using a more cost-effective drug before opting for a more expensive alternative;
• Integration with provincial plans: Pre-submission of claims to provincial programs;
• Drug utilization review program: Process for ensuring that medications are taken appropriately;
• Member awareness: Communication program geared to members to encourage them to adopt responsible practices.
  

Members can help bring down drug costs

While employers can address costs through targeted actions, individual employees can also do their part if they fully understand the benefits for themselves and their plan. If all your plan members follow best cost management practices, you could see recurring savings of 10% to 30%. That’s huge!

Our exclusive approach to raising awareness and communicating with employees in order to change drug purchasing habits is based on four recommended practices:

• Choose generic drugs
• Ask for a 90-day supply of maintenance drugs
• Shop around for a pharmacy
• Consider using a mail-order pharmacy

These practices reduce costs for both employer and plan member, while preserving the focus on individual health.