1 Working Together for a New Foundation Pharmacy Solutions in Drug Plan Management October 22, 2014 Gary Coles, SVP, Group Administration

Why Cooperate Today’s reality – Private payer plans under pressure Cost growth remains higher for private payers than what the provincial public plans are experiencing Long term sustainability is not assured Employers want aggressive cost management in response to general cost increases, as well as trend towards shifting of costs from hospitals to private payers Note: competition lawyer present at all working group meetings

Where Did This Lead Us Insurers are actively promoting numerous drug plan management solutions to clients Preferred Provider Networks Cost controls at point of service – maximum drug pricing, limitations in mark-up, frequency of dispensing Pharmacy agreements Strategies to eliminate waste – Extending supply, Therapeutic Substitution, lower cost alternatives, promoting adherence Case management – including health coaching Insurers cannot implement these solutions without Pharmacy partnership

Making the Co-operation Work In June 2013, CLHIA released a Prescription Drug Policy paper – 1 recommendation was that there be a continued, thoughtful expansion of the scope of practice for Pharmacists 9000 Points of Care Creation of the Pharmacy and Health Insurance Steering Coalition –Mandate: Facilitate ongoing discussion between senior representatives of private sector insurers and pharmacy –Objectives: Identify Common Areas of Interest and opportunities to collaborate

First Steps First Priority – expanding Covered Pharmacy Services Creation of a Services ‘tool-kit’ Developing Reasonable and Customary Guidelines Using Health Spending Accounts (HSA) as the Entry Point

How you can get Involved Communicate the Benefits Promote the Services Develop the Support Necessary to Provide the Services Provide value to your Clients