1. Chris Monteith- General Motors of Canada Limited Jim Beaudry - CAW Sal Cimino - Green Shield Canada A SMOKING CESSATION PROGRAM

2. PERSPECTIVE 1)Plan Sponsor 2)Labour 3)Plan Administrator

3. PERSPECTIVE 1)Pl a n S p o n s or 2)La bo ur 3)Pl an A d mi ni str at or

4. Plan Sponsor’s Perspective  GMCL/CAW Health and Wellness Program known today as ‘Motoring to Wellness’ launched new smoking cessation program September 2006  Designed for GMCL employees, retirees and their family members  In partnership with Durham Region Health Department and Green Shield Canada

5. Plan Sponsor’s Perspective  Theme of Fall 2006 campaign  Program very timely as the Smoke Free Ontario Act came into effect May 31, 2006  Key Campaign Messages –Increase awareness of health effects of tobacco use –Increase awareness of health effects of 2 nd hand smoke –Provide supports to those who wish to quit smoking

6. Plan Sponsor’s Perspective  Health & Wellness Employee Survey conducted Spring 2006 revealed: –18.4% GMCL employees were current smokers –50.5% were considering quitting in the next 6 months (contemplation) or committed to quitting in next 30 days (preparation) –38.3% were not considering quitting

7. Plan Sponsor’s Perspective  Unique program design included combination of motivation, education and support –Intervention support through pharmacists trained in clinical tobacco intervention (CTI) –Participants accessing pharmacists support provided benefit coverage for all NRT –Support material including Self-help resources (e.g. websites, phone lines) CTI trained pharmacist listing

8. Plan Sponsor’s Perspective  Combination of pharmacotherapy and professional support considered to be program’s key to improve quit rate –GMCL committed to helping participants be successful –GMCL covered related pharmacist cognitive fees in addition to NRT costs

9. Plan Sponsor’s Perspective  180 individuals registered  Approximately 50% of those registered took advantage of the CTI trained pharmacist/NRT coverage offering  Outcomes of that 50% signified success of Program  Health Canada has approved funding support for 2008 Program

10. PERSPECTIVE 1)Pl an S po ns or 2)L a b o ur 3)Pl an A d mi ni str at or

11. Labour’s Perspective  CAW behind initiative 100% –Program excellent example for other sectors of our Union –Demonstrates value of working closely with benefit providers to achieve Wellness Program success –Improved quality of life for our members

12. PERSPECTIVE 1)Plan Spon sor 2)Labo ur 3)Plan Ad mini stra tor

13. Plan Administrator’s Perspective 1)Eligible vs Ineligible benefits 2)Trained Pharmacists 3)Electronic Adjudication 4)Communication 5)Data Mining

14. Plan Administrator’s Perspective Eligible vs Ineligible Benefits  Oral smoking cessation products (e.g., Champix, Zyban®) full benefit of the drug plan  Nicotine replacement therapy (NRTe.g. patches, gum) removed from the plan in 2001 due to “unscheduled” status  Programming to “include” the NRT

15. Plan Administrator’s Perspective Trained Pharmacists  “The intervention was associated with increased and more highly rated counselling, and a trend toward higher smoking cessation rates, indicating that community pharmacy personnel have the potential to make a significant contribution to national smoking cessation targets.” Sinclair HK et al. Training pharmacists and pharmacy assistants in the state-of-change model of smoking cessation: a randomised controlled trial in Scotland. Tob Control 1998 Autumn;7(3):253-61

16. Plan Administrator’s Perspective Trained Pharmacists  About 1,000 CTI trained pharmacists in Ontario (CTI = clinical tobacco intervention)  CTI uses “state-of-change model” for smoking cessation  Engaged chains & banners  Over 250 pharmacists committed initially

17. Plan Administrator’s Perspective Electronic Adjudication  Using the existing claims form CPhA v.3  Tie the “consultative” claim to payment AND  Allow for ineligible benefits to be eligible on individual basis i.e. pay for patches, gum, etc.

18. Plan Administrator’s Perspective Electronic Adjudication  Need for pharmacists to understand  Presentation was prepared and delivered in specific areas of concern (e.g. Oshawa, Windsor)  Green Shield website used to inform pharmacists of process; two Green Shield pharmacists dedicated for FAQ & troubleshooting

19. Plan Administrator’s Perspective Communication  Plan members - basically through GMCL and CAW with help from Durham Health  Pharmacists via mailings, presentations, faxes, chains, banners

20. Plan Administrator’s Perspective Data Mining  “How many succeeded?”  Also important to note the “persistence”

21. Number of Patients Number Relapsed/ Withdrawn Number Quit% Quit By GenderBy Gender a Male47252246.8% Female3325824.2% By Employee/DependentBy Employee/Dependent b Employees53282547.2% Dependents2722518.5% Total805030 37.5% a p= 0.034, Fisher exact test b p= 0.011, Fisher exact test

22. Plan Administrator’s Perspective Persistence  Pierce and Gilpin (2002) 1 : – Median duration of OTC NRT use: 14.0 days – Mean duration of OTC NRT use: 28.2 days  Uncontrolled Rx 2 : 39-45 days (mean)  GMCL intervention group 2 : 61.2 days (mean)