Specialty Drug Care –
supporting members, supporting you
Specialty Drug Care helps facilitate access to specialty drugs for plan members who need it while helping keep drug plans sustainable.
Since the fall of 2014, our Specialty Drug Care program has been helping plan members and their dependants who need access to specialty drugs. Specialty drugs aren’t typical prescription drugs; they treat complex chronic and life‑threatening conditions, and are often prescribed by a specialist and require a nurse to assist with administration.
Specialty drugs also have a major cost impact on drug plans. They usually come with a higher price tag than traditional medications, ranging from $7,200 to more than one million dollars per patient per year! For plans, although they represent two per cent of all claims, they account for a total of 29.9 per cent of all plan dollars spent in 2015. The footprint left by specialty drugs is massive – and it’s expected to grow to 42 per cent by 2020, with a double-digit annual trend growth over the next several years1.
This is why a program like Specialty Drug Care – with both cost savings and augmented health support for plan members and their families – is needed to help keep drug plans sustainable. We’re happy to share the success story of Specialty Drug Care – both for patients who need support with specialty drugs and plan sponsors like you, who may be concerned about the effect of specialty drugs on plan costs.
How the program works
By working with Bayshore HealthCare Ltd. – one of Canada’s largest private healthcare companies – Specialty Drug Care combines drug cost savings with nurse case manager support.
When a plan member or their dependant is prescribed a specialty drug, and the patient’s condition satisfies the criteria for coverage, a nurse case manager reaches out to the member by phone to introduce them to the Specialty Drug Care program and make arrangements for them to receive their medication at Manulife’s negotiated rate.
The difference a nurse case manager can make
Throughout the course of a patient’s treatment, their nurse case manager remains a central point of contact, serving as an educational resource and health coach to help the patient better manage their medication, condition, and overall health.
A nurse case manager may
- Provide coaching to the patient to make lifestyle changes such as diet, exercise, stress and smoking cessation
- Engage drug manufacturers’ patient assistance programs to ensure that the plan member is aware of the services and funding available through those programs
- Educate the patient about their medication, condition and the Specialty Drug Care program
- Investigate multiple financial support programs that could assist the plan member with out of pocket costs
- Coordinate injection training sessions and medication infusion appointments
- Arrange efficacy testing with physicians to ensure the therapy is working, if applicable
- Monitor the patient’s adherence to therapy to help ensure that these expensive specialty medications are taken as prescribed
Nurse case managers are at the core of the Specialty Drug Care program, and they use techniques such as motivational interviewing to assess a patient’s readiness for change, support patient engagement and provide health coaching. They do more than just help each patient adjust to their treatment plan; they help them feel confident about it.
Stories of patient experiences
See how the resources offered by the Specialty Drug Care Program can help members become more informed healthcare consumers, pay less out‑of‑pocket, and feel confident in their treatment plans.
Patient support and advocacy
After starting a new asthma medication, a plan member experienced severe itchiness from head to toe. She contacted her nurse case manager, who immediately took these concerns to her physician. Her physician was able to see her within the same day and prescribe an alternative medication. As a result, the allergic reaction soon resolved.
Plan member savings on high cost drugs
A plan member who had been taking a drug for seven months was referred to Bayshore when their employer added the Specialty Drug Care program to their benefit plan.
The nurse case manager discovered that the patient was not enrolled in the drug-specific patient assistance program that would save the patient more than $200 every time they had their prescription filled.
The nurse case manager facilitated an urgent enrolment with the drug manufacturer’s patient assistance program, which covered 100 per cent of the patient’s co-pay going forward. The member was very thankful to the nurse case manager for helping to arrange these savings on their behalf.
Specialty Drug Care saves an average of seven per cent per fill. One Harvoni patient switched to Bayshore and saved $88 per day for 12 weeks – a total of $7,3922!
Proactive, one-on-one patient support
A plan member was concerned about the side effects of a specialty drug she was prescribed, which included a lowered immune system response. The member contacted her nurse case manager, who helped her draft a list of questions for her physician about these side effects, as well as the expected outcomes of the treatment. She chose to take the specialty drug, and afterwards wrote to the nurse case manager to express her gratitude for the one-on-one support she received.
100 per cent of plan members surveyed reported:
- A positive rating of the Specialty Drug Care program
- A positive experience with their Bayshore nurse case manager
- A positive experience with Bayshore’s pharmacy delivery
94 per cent of plan members indicated that Specialty Drug Care added value to their benefit program. From survey results3 to individual stories of success, it’s clear that Specialty Drug Care makes a positive difference for plan members.
Our program is growing
The Specialty Drug Care program has been well received by both our plan sponsors and plan members. In the fall of 2016, this program will be a standard feature of all Manulife drug plans, reaching more plan members and helping them manage these complex medical conditions.
Some of our future innovations include an oral oncology program and an integrated disease management program for high cholesterol, diabetes and hypertension.
The Specialty Drug Care program is as much a patient care program for members as it as a financial protection program for sponsors. When patients participate in an expanded circle of care and reduce or eliminate their out of pocket spend, plan sponsors benefit as well – not only through plan savings – but through improved engagement and productivity. It’s that simple.
To learn more about the Canadian pharmacy landscape, visit manulifebalance.ca
1 Express Scripts Canada 2015 Drug Trend Report.
2 Based on 12 per cent pharmacy mark up from manufacturer’s price list and $10 dispensing fee.
3 All results taken from Bayshore HealthCare patient feedback survey, as of December 3, 2015.
GB3870E Summer 2016