THE SANOFI CANADA HEALTHCARE SURVEY - Closing Knowledge Gaps 2019
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2019
C A N A D A ’ S P R E M I E R S U R V E Y O N H E A L T H B E N E F I T P L A N S
THE SANOFI CANADA
HEALTHCARE SURVEY
Closing
Knowledge
Gaps
2019
THE SANOFI CANADA
HEALTHCARE SURVEY
TABLE OF CONTENTS
Closing
CHAPTER 1 knowledge gaps
Health &
Chronic Disease
4 Multiple facets of health ANDREA FRANKEL
Private Payer Lead
5 Important role of workplace SANOFI CANADA
wellness
6
Employer profile: Being mindful Welcome to the 2019 edition of The Sanofi Canada Healthcare Survey. We
about safety and health chose the theme “Closing Knowledge Gaps” due to the number of significant
7 Doing more for chronic disease gaps that rose to the surface during the advisory board’s analysis of this year’s
survey results. As well, knowledge gaps can be effective springboards for
8 Closer look: Atopic dermatitis
positive changes. By closing these gaps, we can address issues that meet
the needs of both plan members and plan sponsors, in order to create better
CHAPTER 2
health benefit plans. Here are some of the gaps presented in this year’s report:
Understanding • Both plan members and plan sponsors significantly underestimate the
Health Benefit Plans number of drugs covered by their workplace prescription drug plan.
• Plan sponsors continue to underestimate the presence of chronic disease
10 Quality assessments
or conditions in their workforce, which suggests they could also be
14 How benefit plans work underestimating their impact.
16 Private drug plans misunderstood • Improved physical fitness is a priority for plan members, whereas improved
17 Closer look: Pharmacare mental health is a priority for plan sponsors investing in wellness initiatives.
• Four out of five plan sponsors would like to better understand absenteeism
in their workforce.
CHAPTER 3
Looking Ahead Additional knowledge gaps emerged on topics such as the funding of
at Benefits health benefit plans, responses to plan changes, possible scenarios for
national Pharmacare…and more. Our intent is that the identification of these
20 Taking aim at engagement gaps—as well as the exciting alignment of opinions between plan members
21 Closer look: Adult vaccinations and plan sponsors in yet other areas—will serve as compelling food for
22
Changing menu for thought for all stakeholders, who can further use these findings to help guide
health benefits decision-making. With that in mind, this year’s report also includes “3 Steps
24
Employer profile: A holistic for a Healthier Health Benefit Plan,” a simple one-page plan for positive
approach to wellness changes (page 32).
CHAPTER 4
NOTE FROM DANNY PEAK
Analysis & After 11 years shepherding The Sanofi Canada Healthcare
Decision-Making Survey, I am pleased to pass the baton on to Andrea
26 Better analysis for better health Frankel, Private Payer Lead at Sanofi Canada. These years
28 Taking decisions to the next level have been a fascinating journey for me, as a representative
30 Closer look: Drug plan costs of the pharmaceutical industry. Perhaps the most important learning of all
32
3 steps for a healthier health is the need to nurture our shared commitment to improve the health and
benefit plan productivity of working-age Canadians and their families. With this as our
common ground, we can take health benefit plans to the next level.
—Danny Peak
2 THE SANOFI CANADA HEALTHCARE SURVEY | 2019 CANADA’S PREMIER SURVEY ON HEALTH BENEFIT PLANS
Let’s innovate, together
MICHAEL MULLETTE
President and CEO
SANOFI CANADA
Now in its 22nd year, The Sanofi Canada Healthcare Survey and most used part of the employee health benefit plan.
is an expression of our commitment, as a pharmaceutical It’s crucial that, together, we ensure the private sector can
manufacturer, to collaborate with all stakeholders across the continue to offer this benefit to employees and their families,
benefits industry to improve healthcare in Canada. Our goal while working collaboratively with government to improve
is to help ensure that health benefit plans deliver the best the existing private-public system.
possible health outcomes while also improving employee On the private side, we can see that health benefit plans
productivity. are indeed evolving to make space for greater innovation.
As the sponsor of a health benefit plan and provider of a Virtual care and pharmacogenetic testing are just two
workplace environment that promotes health and wellness, examples. Yet there is a growing sense that we can do
you are in some ways better positioned than the public more to push the envelope. The Sanofi Canada Healthcare
system to positively influence the health of your employees. Survey is a tool for the private health insurance industry to
Through health benefits and organizational health and move these types of discussions forward and help guide
wellness initiatives, plan sponsors have the agility to make decision-making.
a positive impact in preventative healthcare and chronic A theme that emerges year after year in this report—one
disease management, in ways that can become an example that is echoed by the Survey’s multi-stakeholder advisory
for the public system. board—is that we can do more together. Let’s use that
The Sanofi Canada Healthcare Survey has consistently mindset to achieve our common goal to improve the health
shown that the prescription drug plan is the most valued and productivity of Canadians.
Thank you to our Sponsors
For 22 years, The Sanofi Canada Healthcare Survey has monitored the pulse of health
benefit plans, analyzing the changing opinions of plan members and plan sponsors on
topics including workplace wellness, health concerns and the impact of chronic disease.
DIAMOND SPONSORS: GOLD SPONSORS:
CANADA’S PREMIER SURVEY ON HEALTH BENEFIT PLANS THE SANOFI CANADA HEALTHCARE SURVEY | 2019 3
CHAPTER 1 H EALTH & C H RO N IC DI S EAS E
Multiple facets of health
Job satisfaction, financial health and the workplace environment all influence plan members’ perceptions of
their physical health, setting the stage for plan sponsors to play an important supporting role. Plan sponsors
would also benefit from raising awareness of the link between physical and mental health.
Health good, though it depends PLAN MEMBERS
• Forty-nine percent of plan members describe THE MAIN THING PLAN MEMBERS WOULD LIKE TO DO TO
their health as excellent or very good, dropping IMPROVE THEIR HEALTH
to 39% among those who have a chronic
disease or condition, and 26% among those
who regularly take three or more medications.
• Just 36% of plan members who are not 56% 46% 43% 34%
Exercise/physical activity Eat healthy Get enough sleep Manage stress levels
satisfied with their job say their health is BASE: All plan members (N=1,505)
excellent or very good; plan members who
state their health benefit plan does not meet HIGHS + LOWS PLAN MEMBERS
their needs are less likely to be in excellent PLAN MEMBERS WHO ARE SATISFIED WITH THEIR JOB
or very good health (33%).
85% Workplace wellness culture No workplace wellness culture 62%
• Virtually all plan members (93%) would like
to do at least one thing to improve upon 86% Personal health excellent/very good Personal health poor 57%
their health. They are most likely to point to Quality of benefit plan excellent/
87% very good
Quality of benefit plan poor 50%
exercise/physical activity (56%), followed by
eating healthy (46%), getting enough sleep BASE: All plan members (N=1,505); Size of subgroups varies
(43%) and managing stress levels (34%).
KEY TAKEAWAYS
• Stress management is a bigger factor for plan
members who are not satisfied with their job + Job satisfaction can influence perceptions of personal health.
(46%, compared to 32% among satisfied Members of The Sanofi Canada Healthcare Survey advisory board
plan members). stress that employees respond positively when they feel valued,
and plan sponsors can support job satisfaction through workplace
Link between health, culture and health benefit plans.
finances, benefits
• Sixteen percent of plan members describe + Generational differences can also be considered when
their current financial situation as poor, determining how to tactically support job satisfaction. For
jumping to 40% among those in poor example, millennial-age and younger employees may feel more
physical health. rewarded by new experiences, such as travel to conferences and
• Plan members who are financially unhealthy memberships in industry associations.
are more likely to say the quality of their
health benefit plan is poor (37%) or it does + Keeping in mind that mental illness is a leading cause of disability
not meet their needs (39%). claims and can result in the highest costs per claim,1 plan sponsors
and providers can raise greater awareness of the importance of
mental well-being in overall physical health.
Job satisfaction also
plays key part
• Eighty percent of plan members report being
+ The level of poor financial health is likely underreported. A
2016 study, for example, reveals that almost a third of Canadians
satisfied with their current job, consistent with
feel insecure about their financial health.2 The advisory board
last year (80%).
encourages plan sponsors to offer or facilitate personal financial
• Ratings for job satisfaction are tied to ratings
planning services for employees.
for workplace environment or culture that
1. Dewa CS, Chau N, Dermer S. Examining the comparative incidence and costs of physical and mental health-
encourages wellness and personal health as related disabilities in an employed population. J Occup Environ Med. 2010 July;52(7)758-62.
2. 2016 Sun Life Canadian Health Index.
well as perceptions of the quality of the health
benefit plan (see chart).
4 THE SANOFI CANADA HEALTHCARE SURVEY | 2019 CANADA’S PREMIER SURVEY ON HEALTH BENEFIT PLANS
CHAPTER 1 H E A LT H & C H R O N I C D I S E A S E
Important role of
workplace wellness
A convincing majority of both plan members and plan sponsors agree that their workplace culture
encourages health and wellness. Most employers also plan to invest in at least one area of wellness—though
small employers are much less likely. Mental health is the main area of focus for investments; however, this
focus should not preclude investments in other areas.
PLAN MEMBERS Top marks for wellness culture
• Seventy-seven percent of plan members agree their workplace
HOW A WORKPLACE WELLNESS
CULTURE INFLUENCES PLAN MEMBERS’ culture or environment encourages health and wellness. This
PERCEPTIONS THAT: becomes a key determinant of ratings in other areas, including the
n With wellness culture n Without quality of health benefit plans, personal health and job satisfaction
Quality of health benefit plan 61% (see chart).
is excellent/very good 28% • Eighty-five percent of plan sponsors agree their workplace culture
Plan meets needs 68% encourages health and wellness, which again is an important
extremely/very well 35% determinant of employers’ behaviour in other areas, including
Personal health is 52%
excellent/very good
investments in wellness and setting objectives for health benefit
40%
plans (see chart).
They are satisfied 85%
with their job 62%
BASE: Plan members with a wellness culture (n=1,160); Without a wellness
More to come in wellness
culture (n=345) • Seventy-one percent of plan sponsors intend to invest funding and/
or staff resources in at least one area of employee wellness over the
PLAN SPONSORS next three years, outside of what’s provided under the health benefit
HOW A WORKPLACE WELLNESS plan. Among them, they will most likely dedicate funding/resources
CULTURE INFLUENCES PLAN SPONSORS’
LIKELIHOOD TO: for emotional/mental health (61%), followed by physical fitness (53%),
n With wellness culture n Without prevention of illness and/or management of chronic conditions (48%),
Invest in 74% social well-being (e.g., volunteerism) (42%) and financial health (41%).
wellness 50% • Regionally, plan sponsors based in Quebec are most likely planning
Set specific objectives for their 70% to invest in wellness (86%), compared to 56% in Western Canada.
health benefit plan 39% Quebec employers are also ahead of the rest of Canada in the area
BASE: Plan sponsors with a wellness culture (n=342); Without a wellness of mental health (66%), while employers in Ontario are almost equally
culture (n=61)
focused on prevention/management of illness (56%) as they are on
mental health (60%).
KNOWLEDGE GAP PRIORITIES TO IMPROVE WELLNESS
• Twenty-nine percent of plan sponsors do not plan to invest in any
PLAN MEMBERS PLAN SPONSORS area of employee wellness over the next three years, increasing to
MAIN THING PLAN SPONSORS’ 55% among those employing fewer than 50 people.
PLAN MEMBERS TOP AREA FOR
WOULD LIKE TO INVESTMENT Mental health training on the rise
DO TO IMPROVE IN EMPLOYEE
HEALTH WELLNESS • Fifty-one percent of plan sponsors have a mental health training
program in place for managers and/or employees, up from 37% in
2018. A number of factors appear to influence results in this area
(see chart, page 6).
• One-third of plan sponsors (32%) feel their health benefit plan
56% 61% does not provide enough coverage for psychotherapy or cognitive
Exercise/ Emotional/ behavioural therapy, climbing to 50% among those who also say their
physical activity mental health
workplace environment does not encourage health and wellness.
BASE: All plan members (N=1,505); All plan sponsors (N=403)
Twenty-eight percent do not know if their plan provides enough
coverage for these mental health therapies.
CANADA’S PREMIER SURVEY ON HEALTH BENEFIT PLANS THE SANOFI CANADA HEALTHCARE SURVEY | 2019 5
CHRIS BONNETT • H3 CONSULTING KEY TAKEAWAYS
“The focus on mental health is + Members of the advisory board are encouraged
understandable, but it’s almost to by the number of plan sponsors planning to invest
in wellness, and emphasize the importance of
the point where we may be doing
a strategy to guide decision-making. Providers
a disservice to plan members. We don’t and advisors can reinforce the value of a strategy
want to forget the fact of comorbidities. during and between renewal meetings, as well as
Research shows that almost one in three recommend changes and possible new products
people with cancer also have a diagnosed that fit within the strategy.
mental illness, most often depression and
+ The result for small employers likely reflects their
anxiety. It’s not surprising. Our health strategy limitations in terms of additional investments in wellness;
should include all the conditions that affect however, all employers can take low- or no-cost actions
productivity, well-being and quality of life.” to promote a wellness culture (for example, flexible work
hours and working from home). Benefits consultants
on the board also noted that more small employers are
HIGHS + LOWS PLAN SPONSORS conducting flu shot clinics—the cost to bring in a nurse
PLAN SPONSORS WITH MENTAL HEALTH TRAINING FOR to do the injections is reasonable, when compared to
MANAGERS AND/OR STAFF the cost of a flu outbreak.
73% 500 or more employees Fewer than 250 employees 30%
+ The emphasis on mental health is laudable and
66% Quebec Western Canada 35% reflects plan sponsors’ growing recognition of its
67% From public sector From private sector 45% impact on productivity and disability. Going forward,
however, the board recommends equal emphasis be
69% Unionized Non-unionized 44%
placed on all other areas of wellness, given that all are
Receive analyses of top Do not receive analyses of interrelated (unmanaged chronic disease, for example,
63% disease states top disease states
19%
can lead to a secondary diagnosis of depression).
BASE: All plan sponsors (N=403); Size of subgroups varies
PLAN SPONSOR PROFILE • BC HYDRO
Being mindful about safety and health
It was an employee meeting unlike any other—more than “minds on task” when it comes to doing safe work and
a hundred people had assembled, and you could hear a preventing injury. “The conversation on mindfulness is
pin drop. still alive in people’s minds and we often get requests
That meeting was one of two kick-offs for a 30-day, for mindfulness resources,” says Carolynn Ryan, chief
online challenge in mindfulness, a meditative technique that human resources officer at BC Hydro.
can reduce stress and improve resiliency and focus. The The mindfulness challenge is one of a number of
campaign struck a chord with employees across all types of offerings to promote physical, mental and emotional health
roles within the organization. From the beginning, participation among the crown corporation’s 6,500 employees located
in the mindfulness challenge exceeded BC Hydro’s goal across the province. The benefits team and the health and
by 170%. Overall, 1,800 people participated, including recovery services team work together on benefits design,
400 who attended the kick-off events either live or online. vendor management, program design and delivery, and
Communication and education were critical to success, support for individual employees. Other recent offerings
and mindfulness was clearly linked to BC Hydro’s culture include a financial health campaign and a new mental
of safety. Spokespersons included a former NHL hockey health benefit to support employees and family members.
player turned mindfulness coach, BC Hydro’s president BC Hydro is also participating in a pilot program for virtual
and chief operating officer, who regularly emails staff care, focused on cognitive behavioural therapy.
about the physical and mental benefits of mindfulness, Following the mindfulness challenge, BC Hydro
and employees who shared their stories. Articles on the continues to explore ways to elevate the discussion on
intranet generated more than 13,500 views. mental health, reduce barriers to support and identify
Of the employees who participated, 93% of those opportunities for early intervention. “We want to continue
surveyed agreed that mindfulness is linked to safety. strengthening our culture where everyone feels safe to
It’s easy to recognize the benefit of mindfulness, as focus on their work, and where everyone feels like they
BC Hydro often talks about employees keeping their belong,” says Ryan.
6 THE SANOFI CANADA HEALTHCARE SURVEY | 2019 CANADA’S PREMIER SURVEY ON HEALTH BENEFIT PLANS
CHAPTER 1 H E A LT H & C H R O N I C D I S E A S E
Doing more for
chronic disease
The will is there across all stakeholder groups to do more in the area of chronic disease management,
but the way is not yet clear. Can plan sponsors afford to do more in this space? Can they afford not to?
As awareness grows of the impact on productivity, can the case be made for plan sponsors to incorporate
chronic disease management into corporate strategy?
KNOWLEDGE GAP CHRONIC DISEASE IN THE WORKPLACE Half the workforce affected
• As in past years, more than half of plan members (54%)
PLAN MEMBERS PLAN SPONSORS
report having at least one chronic disease or condition,
PLAN MEMBERS PLAN SPONSORS’
WHO HAVE BEEN increasing to 69% among those aged 55 to 64 and 82%
ESTIMATE OF
DIAGNOSED WITH PERCENTAGE OF among those in poor health.
AT LEAST ONE WORKFORCE WITH A
CHRONIC DISEASE • Plan members in Atlantic Canada are the most likely to have
CHRONIC DISEASE
OR CONDITION OR CONDITION a chronic disease or condition, at 65%.
• Plan members also indicate that 38% of others also covered
54% 39% by their plan (i.e., spouses and dependents) have a chronic
disease or condition.
BASE: All plan members (N=1,505); All plan sponsors (N=403) • The top five chronic diseases or conditions are mental
illness, hypertension, high cholesterol, arthritis and diabetes.
JOHN MCGRATH • ZLC FINANCIAL
Are plan sponsors more aware?
“The gap between plan members
• Plan sponsors estimate that 39% of their workforce
and plan sponsors is closing, but
has a chronic disease or condition, up from 29% a year
it’s still a big gap. We need to take ago. Estimates are more accurate among public sector
awareness of chronic disease to the next employers (51%), large employers with 500 or more
level by connecting the dots between lost employees (44%), and those who receive claims analyses
productivity, absenteeism, the cost of the on disease states (40%).
drugs, disability, etc. But we don’t just need • Employers in Atlantic Canada also appear to be more aware
more reporting—we also need to come up of the presence of chronic disease in their workforce (44%),
with different solutions.” though their estimate still falls well short of actual levels
reported by plan members (65%).
PLAN MEMBERS
And then there’s chronic pain
CHRONIC PAIN AND CHRONIC CONDITIONS
• Forty-two percent of plan members indicate having chronic
42% 67% pain, described as any pain that never really goes away, lasts
Plan members Plan members with
for months or flares up from time to time (e.g., back pain).
with chronic pain a chronic condition
and/or chronic pain This result increases to 71% among those with arthritis.
BASE: All plan members (N=1,505)
• When combined with other chronic conditions and
diseases, 67% of plan members have a chronic condition
HIGHS + LOWS PLAN MEMBERS
and/or chronic pain.
PLAN MEMBERS WHO ARE MANAGING THEIR
CHRONIC DISEASE OR CONDITION VERY WELL
How members are managing so far
59% Workplace wellness culture No workplace wellness culture 44% • Seventy-seven percent of plan members with a chronic
59% Satisfied with job Not satisfied with job 37% disease or condition take at least one medication on a
regular basis, compared to 27% among those without a
61% Quality of benefit plan
excellent/very good Quality of benefit plan poor 36%
chronic disease or condition. Thirty-one percent of plan
60% Plan meets needs Plan does not meet needs 33% members with a chronic condition take three or more
extremely/very well
medications, compared to just 4% of plan members without
BASE: Plan members with chronic disease or condition (n=838); Size of subgroups varies
a chronic disease or condition.
CANADA’S PREMIER SURVEY ON HEALTH BENEFIT PLANS THE SANOFI CANADA HEALTHCARE SURVEY | 2019 7
• Fifty-five percent of plan members with a chronic
CLOSER LOOK: ATOPIC DERMATITIS
disease or condition feel they are managing very
well on a day-to-day basis, and 37% say they are A dermatologist’s “prescription”
managing somewhat well. The perceived quality of for insurance providers
the health benefit plan and the work environment
Dr. Steve Mathieu ruefully describes how some of the
appear to affect people’s ability to manage their adolescents under his care seem to think he should be able
condition (see chart, page 7). to “wave a magic wand” to cure them of the eczema that
• Exercise is one of the top three things plan members plagues them day and night.
would like to do better to manage their condition, cited For his part, Mathieu wishes he could wave a magic wand
to change the rules for insurance coverage, so that these
by 60%, followed by eating healthy foods (49%) and patients can get quicker access to effective treatment.
getting enough sleep (43%). Eczema, or atopic dermatitis (AD), is an inflammatory
• Plan members aged 18 to 34 are more likely to want disease that leads to itchy, red, swollen and cracked
more sleep, at 44%, compared to 36% among those skin. The impact of severe AD on young patients can be
heart-wrenching. “Imagine not being able to sleep at night
aged 55 to 64; on the other hand, plan members aged
because it itches so much,” says Mathieu. “They have
55 to 64 are much more likely to want to do more trouble concentrating at school, their grades drop. Other
exercise (71%) than those aged 18 to 34 (54%). children think they’re contagious, and avoid all contact. I
see how these kids withdraw from life—they may not be
diagnosed with depression, but I’m sure many suffer from it.”
Desire for more support The dermatologist sees how adolescent AD takes its toll
• Eighty-seven percent of plan members with a chronic on parents as well. “They’re also losing sleep and days of
disease or condition would like to know more about work going to doctors’ appointments. And they’re worrying,
their condition and how to treat it, reinforcing results all the time, about how to help their children.”
Some patients with moderate-to-severe AD can be
from 2018 (84%) and 2016 (84%). Similarly, 89% of
treated with at-home care (e.g., warm baths) and topical
those with chronic pain would like to know more about therapies. When these don’t work, the next best option, by
how to manage it. far, is a biologic drug called dupilumab. “It works very well.
• Plan sponsors, meanwhile, would like to do more to Patients get their lives back,” says Mathieu, who practices
help: 82% would like their health benefit plan to do in Quebec City.
However, current insurance reimbursement criteria
more in the area of supporting people with chronic require the trial of one or sometimes even two systemic
diseases, comparable to last year’s result (79%). (oral) medications first, which are off-label for the treatment
• More specifically, 87% of plan sponsors would like their of AD. “These systemic treatments really don’t work very
insurer or benefit advisor to provide possible ways to well, and in adolescents especially, they can be harmful
because their bodies are still growing. The risk of skin
better support chronic disease management. The level
cancer and infections is higher, as well as damage to the
of agreement is strong, with 35% strongly agreeing. kidneys. I dread prescribing these drugs, knowing that
• However, 60% of plan sponsors indicate that concerns dupilumab is a safe and effective option.”
over cost are a big barrier. Twenty-six percent also Dupilumab is not yet approved for use in adolescents,
which means that dermatologists typically seek coverage
indicate that the lack of offerings from insurers is a big
under the exceptional access programs. By the end of
barrier, consistent across all sizes of organizations. 2019, however, Health Canada is expected to approve
• Regionally, plan sponsors in Quebec are less its use for individuals aged 12 to 17. “This is great news.
concerned about costs (47%, compared to 63% for Hopefully private insurers also see it as an opportunity to
update coverage requirements, so adolescents do not have
the rest of Canada).
to try the systemic drugs first. That would be really great
news,” says Mathieu.
OPINIONS ALIGNED MORE SUPPORT FOR CHRONIC DISEASE MANAGEMENT
PLAN MEMBERS PLAN SPONSORS
More about atopic dermatitis
The Sanofi Canada Healthcare Survey reports that 8%
PLAN MEMBERS PLAN SPONSORS WHO of plan members have AD, which supports U.S. research
WHO WOULD WOULD LIKE THEIR data that indicate a prevalence of 7% among adults and
LIKE TO KNOW BENEFIT PLAN TO DO 11% among children.1,2 Based on surveys of Canadians
MORE ABOUT MORE TO SUPPORT
THEIR CONDITION PLAN MEMBERS with AD, about a third have severe AD. The condition can
AND HOW TO WITH CHRONIC significantly impact quality of life due to sleep loss, as
TREAT IT CONDITIONS well as result in reduced physical and social activities,
ostracism and missed time at work and school.3
87% 82%
1. S ilverberg JI et al. Sleep disturbances in adults with eczema are associated with impaired overall
health: a US population-based study. J Invest Dermatol. 2015 Jan;135(1):56-66.
2. Shaw TE et al. Eczema prevalence in the United States: data from the 2003 National Survey of
Children’s Health. J Invest Dermatol. 2011 Jan;131(1):67-73.
3. A topic Dermatitis Quality of Life Report: Moderate-to-Severe Disease. 2016/2017 Survey Results.
Eczema Society of Canada. 2017 June. Accessible at https://eczemahelp.ca.
BASE: Plan members with chronic condition (n=838); All plan sponsors (N=403)
8 THE SANOFI CANADA HEALTHCARE SURVEY | 2019 CANADA’S PREMIER SURVEY ON HEALTH BENEFIT PLANS
JONATHAN TAFLER • HEALTH SOLUTIONS BY SHOPPERS DRUG MART KEY TAKEAWAYS
“As an industry, we can do + Members of the advisory board stress that chronic
a better job with business disease can be better addressed, given its prevalence in
the workforce and dominant role in health benefit plans.
casing around chronic disease
For every $100 in private drug-plan costs, $65 is for
management programs. We talk about drugs to treat chronic diseases.1
the need for an ROI, but is that really the
case when a lot of benefits paid for today + Education on prevalence could be an important first
do not have a clear ROI? We need to shift step to prevent feelings of stigma that are a barrier to
effective self-management. Stigma is not just an issue
to prevention now, because our current
with mental illness, but also with many other chronic
path—where too many people with conditions, in particular the so-called “lifestyle” conditions
chronic diseases get sicker, need more such as obesity, type 2 diabetes and high blood
drugs and finally can’t work anymore—is pressure.
not sustainable.”
+ Management training is also important to prevent
stigma and encourage disclosure, which in turn enables
PLAN MEMBERS the accommodation of treatment.
AMONG PLAN MEMBERS WITH A CHRONIC
CONDITION, THE MAIN THINGS THEY + The level of chronic pain reported by plan members is
WOULD LIKE TO DO TO BETTER MANAGE “surprising” and “scary,” note advisory board members,
THEIR CONDITION and a call to action is needed to develop programs to
mitigate the long-term negative impacts on productivity
Exercise/get enough
physical activity 60% and costs.
Healthy eating 49% + Perceptions on affordability and the lack of offerings
from insurers can be seen as interconnected, suggesting
Get enough sleep 43% the need for better education through reporting and
more innovative, evidence-based offerings, perhaps in
Lose/maintain weight 42% collaboration with external partners.
Manage stress levels 34% + To further mitigate plan sponsors’ concerns about
affordability, the advisory board suggests the exploration
Alternative therapies
(e.g., physiotherapy) 19% of alternative pricing strategies that would encourage
plan sponsors to add chronic disease management
Take vitamins and other programs to their benefit plan.
13%
supplements
+ Carriers, advisors and HR staff can also reframe
Counselling for mental/ 12% affordability by highlighting the costs of inaction and
emotional health
considering whether plan sponsors can afford not to invest
in the prevention and management of chronic disease.
Take prescription
12%
medications
+ The issue of affordability becomes moot if plan
BASE: Plan members with chronic condition (n=838) members do not use the new benefits. Participation
levels are very low in the few chronic disease programs
CARLEE BARTHOLOMEW • RBC INSURANCE
already available, notes the advisory board. For more on
plan member engagement, see page 20.
“Many different initiatives and
approaches are becoming + Advisors are urged to consistently raise awareness of
the level and impact of chronic disease in the workplace
available in chronic disease
so that connections can be drawn to business outcomes.
management. But at the end of the day, Supports and accommodation for chronic disease can be
it comes down to how do we get the plan built into corporate strategy, as part of occupational health
members on board, keeping in mind that and safety, and adapted to meet the needs of employers
stigma could be a big issue. We’re going of all sizes and sectors.
to need new and different approaches for 1. Private Drug Plan Drug Cost Forecast (2018-2020). Innovative Medicines Canada, based on
analysis by IQVIA Solutions Canada.
participation, as well.”
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CHAPTER 2 U N D E R S TAN DI N G H EALTH B E N E FIT PL AN S
Quality assessments
Perceptions of the quality of the health benefit plan appear to be reassuring at first, but become troubling
when we zero in on ratings from plan members in poor health. Other measures of quality—perceived impact
of changes, opinions on improvements and appeals for coverage—give generally positive or mixed results;
however, low levels of awareness also come to the surface.
Link between quality and health HIGHS + LOWS PLAN MEMBERS
• Fifty-four percent of plan members judge the quality QUALITY OF PLAN EXCELLENT/VERY GOOD
of their health benefit plan to be excellent or very Personal health excellent/
67% very good
Personal health poor 45%
good; this result has hovered around the halfway
mark since first asked in 2006. However, plan No workplace wellness
61% Workplace wellness culture
culture
28%
members in poor health—who are most in need
of health benefits—are much less likely to be very 58% Satisfied with job Not satisfied with job 36%
positive (see chart). 62% Flex plan Traditional plan 51%
• Only 7% of plan members describe the quality of their
Have a health spending Do not have a health
plan as poor; however, this increases to 19% among 61% account spending account
50%
those in poor health.
61% No maximum on drug plan Maximum on drug plan 51%
• Plan design is a factor: plan members with flex plans
BASE: All plan members (N=1,505); Size of subgroups varies
and health spending accounts (HSAs) are more likely
to be very positive about their health benefit plan
KNOWLEDGE GAP CHANGES TO HEALTH BENEFIT PLANS
(see chart).
• Sixty percent of plan members agree their plan meets
their needs extremely or very well, consistent with last AWARENESS OF CHANGES MADE
TO THEIR HEALTH BENEFIT PLAN
year (62%). Again, those in poor health are much less IN THE PAST TWO YEARS
likely to agree (49%).
PLAN MEMBERS PLAN SPONSORS
• Three out of four plan members (76%) agree that they
would not move to a job that did not include a health
benefit plan, unchanged from 2015 (77%), when this 49% 72%
question was last asked.
• Plan sponsors (61%) are somewhat more likely
BASE: All plan members (N=1,505); All plan sponsors (N=403)
than plan members (54%) to describe the quality
of their organization’s health benefit plan as excellent
PLAN MEMBERS PLAN SPONSORS
or very good. However, the number of plan sponsors
describing their plan as excellent increased to IN RESPONSE TO THESE CHANGES,
PLAN MEMBERS AND PLAN SPONSORS…
24% from 14% in 2018, while this result did not
n Think better of their plan
improve among plan members (19% in 2018, n Think less of their plan
17% in 2019). n Want to understand the impact
Mixed opinions on changes to plan 23%
• Just about half of plan members (49%) report that 33%
changes were made to their benefit plan in the past 37%
Plan Plan
two years. Fifty-one percent do not know of any members sponsors
55%
changes, which could indicate that changes did 22%
not occur or that plan members were not aware 30%
of the changes.
• Among those who do know of changes, 37% think better BASE: Plan members who know of changes to plan (n=735); Plan sponsors who know of
changes to plan (n=290)
of the plan as a result, 30% think less of their plan and
33% want to understand the impact of the changes.
10 THE SANOFI CANADA HEALTHCARE SURVEY | 2019 CANADA’S PREMIER SURVEY ON HEALTH BENEFIT PLANSDAVE PATRIARCHE • MAINSTAY INSURANCE BROKERAGE • Members with flex plans (45%) and HSAs (51%) are
more likely to think better of their plan, as are those
“It’s safe to say that virtually every who already consider their plan to be excellent or very
benefit plan in Canada has seen good (52%).
at least one change in the last two • In contrast to plan members, 72% of plan sponsors are
years. The gaps in awareness, especially aware of changes made to their plan in the past two
among employers, is a concern. This all years, leaving 28% who do not know of any changes.
comes down to communication—carriers, • Also in contrast to plan members, 55% of plan sponsors
advisors and plan sponsors simply have think better of their plan as a result, 22% think less of
to make sure that everyone understands their plan and 23% would like to understand the impact
what’s happening, and why it’s happening.” of the changes.
Plan members willing to pay more?
HIGHS + LOWS PLAN SPONSORS • Seventy-four percent of plan members would like more
WHAT PLAN SPONSORS CONSIDER TO BE THE MOST flexibility and the ability to trade-off what their plan covers
IMPORTANT CHANGES TO IMPROVE HEALTH BENEFIT and for how much. This is consistent with the 71%
PLANS: REGIONAL VARIATIONS reported in 2014, when this question was last asked,
and the result does not change for plan members who
already have a flex plan (74%).
Improved coverage options for higher-cost specialty drugs
• Fifty-three percent of plan members would be interested
51% Ontario Western Canada 31% in paying more out of pocket for extra coverage, up from
49% in 2014 and 47% in 2006, and increasing to 62% in
Quebec and 60% among those with flex plans.
More benefits to prevent illness
49% Quebec Western Canada 27%
More benefits to manage chronic disease Group benefits your
43% Ontario Quebec 24%
employees will actually
benefit from
Improved disability management
32% Quebec Western Canada 22%
Fraud detection and prevention
26% Ontario Western Canada 11%
BASE: All plan sponsors (N=403); Regional size varies
MARK ROLNICK • HEALTH SOLUTIONS BY SHOPPERS DRUG MART
“There seems to be a trend
toward plan members’ willingness
to contribute. Perhaps this is
signalling that, as we think more about Talk to your Group Benefits Advisor,
wellness and preventative solutions, there call RBC Insurance at 1-855-264-2174 or
visit rbcinsurance.com/group-benefits
is an openness to a shared-cost or co-pay
model, like most benefit plans, rather
than employers having to cover all costs,
as they do for an employee assistance
program, for example.” Underwritten by RBC Life Insurance Company.
® / ™ Trademark(s) of Royal Bank of Canada. Used under licence. VPS104442 122579 (04/2019)
CANADA’S PREMIER SURVEY ON HEALTH BENEFIT PLANS THE SANOFI CANADA HEALTHCARE SURVEY | 2019 11Plan sponsors’ wish lists KEY TAKEAWAYS
• When asked to choose from a list of five possible + The advisory board cautions against
improvements for their health benefit plan, plan sponsors complacency when interpreting results for the
most often chose improved coverage options for
quality of the health benefit plan. Since most plan
higher-cost specialty drugs as most important (39%),
members are in good health and use the plan
followed closely by more benefits to prevent illness
infrequently, the dominant ranking of “good” is
(36%) and more benefits to manage chronic disease
(34%). Improved disability management (25%) and fraud in part a default response that reflects neither
detection/prevention round out the list (19%). Regionally, positive nor negative feelings. On the other hand,
interesting variations emerge (see chart, page 11). the finding that one in five members in poor health
• Just 12% of plan sponsors consider none of the options ranks their plan as poor is a cause for concern.
to be important as possible improvements, increasing to
21% among small employers (fewer than 50 employees). + Results confirm that the health benefit plan
effectively helps attract and retain employees, as
Closer look at appeals the majority would not go to a job that did not have
• Forty-four percent of plan members report their health a plan.
benefit plan has denied coverage of a claim, most often
for a dental service (20%), prescription drug (15%) or
+ While plan sponsors are more likely to know
paramedical service (13%).
of changes to the plan than plan members, the
• Among those who were denied coverage of a
advisory board notes that knowledge does not
prescription drug, 35% requested a review of the
necessarily translate into a full understanding of
decision. Put another way, 5% of all plan members
appealed a denial of coverage for a prescription drug. the impact of the changes.
Within that subset of respondents, 49% say that the
decision was reversed and they received coverage, + The advisory board also notes that plan
and 47% reported no change and no coverage. members’ openness to trading off benefits and
• Just 23% of plan sponsors, meanwhile, indicate that paying for increased coverage could indicate a
they know the number of appeals made by plan desire for improved health benefits. It could also
members seeking coverage for items that were initially suggest a willingness to share costs for new
denied coverage. Almost half (48%) do not know the benefits for wellness, such as coaching for chronic
number of appeals, and 29% report that appeals rarely
disease management.
or never happen.
• Among plan sponsors who do not know the number of
appeals, 55% would like to know.
+ The fact that plan sponsors rank coverage for
higher-cost drugs and benefits to prevent illness
• Among those who do know the number of appeals,
31% say it has increased in the past several years, and benefits to manage chronic disease as almost
while 60% say it has remained the same. Half of these equally important to improve the benefit plan is
plan sponsors (53%) add that this is a concern for encouraging; however, it’s somewhat surprising
their organizations. that improved disability management did not
receive a high ranking as well, given that it is
PLAN SPONSORS
relatively easy to implement improvements and
PLAN SPONSORS WHO KNOW THE NUMBER measure results.
OF APPEALS FOR COVERAGE MADE BY
PLAN MEMBERS
+ Improved disability management can also circle
29% 23% back to improved chronic disease management
Appeals rarely Yes
or never happen in the workplace in two ways: employees will be
better equipped to self-manage their condition
after they return to work; the workplace will be
22%
26% No better able to accommodate employees’ care
No, but would
like to know requirements.
BASE: All plan sponsors (N=403)
12 THE SANOFI CANADA HEALTHCARE SURVEY | 2019 CANADA’S PREMIER SURVEY ON HEALTH BENEFIT PLANSKeeping your
best interests
in mind
We believe personal health and financial wellness go hand in hand.
Our group benefits and group retirement savings solutions ensure your
employees have a holistic and seamless experience. We’re committed
to helping your employees achieve their overall wellness goals through
every stage of life, so they can live the lives they really want to live.
To find out how we can help your employees make the most of a Desjardins
group plan, please take a minute to watch our video posted on:
desjardinslifeinsurance.com/businesses
Desjardins Insurance refers to Desjardins Financial Security Life Assurance Company.CHAPTER 2 U N D E R S TA N D I N G H E A LT H B E N E F I T P L A N S
How benefit plans work
This year’s survey revealed a number of knowledge gaps when it comes to plan members’ basic
understanding of their health benefit plan—almost half, for example, expect their plan to continue after
retirement. Misconceptions or lack of awareness are also apparent when it comes to levels of coverage and
what is actually covered.
Perceptions . . . and misconceptions PLAN MEMBERS
• Four out of five plan members (83%) believe their employer pays PLAN MEMBERS WHO BELIEVE THAT…
a fixed cost to the insurance company for their health benefit
plan, no matter how much or how little the plan is used. 83%
Their employer pays a fixed cost to the insurance
• Almost half (48%) believe that they will still have access to their company, no matter how much or how little the
workplace health benefit plan after retirement. As expected, benefit plan is used
those who work in the public sector (53%) are more likely to
expect continued benefits than those in the private sector (35%).
• Sixty-four percent of plan members believe that if they were 48%
referred to a mental health professional not covered by the After retirement, they will still have access to their
workplace health benefit plan
provincial health plan, their benefit plan would cover all costs.
• Only 39% of plan members are aware that medical devices BASE: All plan members (N=1,505)
(e.g., sleep apnea machines) and certain medications are
not automatically covered by their benefit plan, and that their
KNOWLEDGE GAP AUTOMATIC COVERAGE
employer may need to request coverage. This drops to just
28% among plan members in poor health. AWARENESS THAT MEDICAL
DEVICES AND CERTAIN
• Meanwhile, 62% of plan sponsors are aware that medical MEDICATIONS MAY NOT
devices (e.g., sleep apnea machines) and certain medications AUTOMATICALLY BE COVERED,
are not automatically covered, and that they may need to AND THAT THE EMPLOYER
MAY NEED TO REQUEST THAT
request that coverage be added to their benefit plan. COVERAGE BE ADDED TO THE
Employers in Atlantic Canada (75%) and those with unionized BENEFIT PLAN
workforces are especially aware (72%). PLAN MEMBERS PLAN SPONSORS
39% 62%
BASE: All plan members (N=1,505); All plan sponsors (N=403)
PIERRE MARION • MEDAVIE BLUE CROSS
“Putting a cap on drug plans
is like capping your house
insurance at $15,000. From an
insurance point of view, it doesn’t make
sense for anybody. We must work to give
access to specific higher-cost drugs
and to chronic disease medications.
For both, the challenge is to find a
reasonable out-of-pocket maximum for
the participant.”
14 THE SANOFI CANADA HEALTHCARE SURVEY | 2019 CANADA’S PREMIER SURVEY ON HEALTH BENEFIT PLANSBARB MARTINEZ • THE GREAT-WEST LIFE ASSURANCE COMPANY Maximums matter
• Sixty-six percent of plan members know that their health
“As drug claims management
benefit plan has maximums in place to limit coverage for
programs have been introduced certain benefits, 10% indicate there are no maximums
over time, the communication and 24% do not know.
message has not always gone along with • Plan sponsors are more aware of maximums, but not by
it. This has led to a knowledge gap for much more: 75% confirm that their plan has maximums
both plan members and plan sponsors. for certain benefits, 14% say there are no maximums and
It’s really important that plan sponsors 12% do not know.
fully understand what their programs offer, • When asked specifically about drug plans, 21% of plan
and that plan members understand how sponsors report having a maximum in place, up slightly
benefits are paid and how their behaviour from 17% in 2018. The average maximum amount is
affects cost.” approximately $7,800. There is no variation between
employers with more than 500 employees (22%) and
employers with fewer than 50 employees (23%).
KEY TAKEAWAYS • Among plan members, more than half (55%) do not
know if their drug plan has a maximum; 11% report
+ As more changes to health benefit plans are that it does.
made or considered, it becomes more important
for plan members and plan sponsors to increase
their knowledge and understanding of how
benefit plans work, and the impact of changes.
For example, plan members need to have a better
understanding of how plans are funded, and that
inappropriate utilization drives up costs.
+ The status of health benefits upon retirement
also needs to be clearly communicated, as
misconceptions about the continuation of private
benefits could be a liability risk for employers
(particularly in the private sector, where very
few plans continue after retirement).
+ The growing pipeline for specialty drugs
highlights the importance of the drug plan’s
role as a source of pure insurance. However,
existing stop-loss programs were not designed
for higher-cost drugs used to treat chronic
diseases or conditions. The small but growing
number of drug plans with maximums adds
urgency to the need to evolve insurance
programs.
+ If a drug plan maximum is in place, the advisory
board emphasizes the need to be transparent to
plan members and to proactively communicate
the next best actions when the maximum is
reached.
CANADA’S PREMIER SURVEY ON HEALTH BENEFIT PLANS THE SANOFI CANADA HEALTHCARE SURVEY | 2019 15CHAPTER 2 U N D E R S TA N D I N G H E A LT H B E N E F I T P L A N S
Private drug plans
misunderstood
Plan members are somewhat accurate in their estimates of personal utilization of the drug plan and the
resulting spend, but appear to be hugely unaware of the major differences between private and public
plans. Survey results on national Pharmacare are contradictory, reflecting low levels of knowledge among
both plan members and plan sponsors.
Private viewed to be on par with public KNOWLEDGE GAP ESTIMATING DRUG COVERAGE
• Both plan members and plan sponsors believe that PLAN MEMBERS’ AND PLAN SPONSORS’ ESTIMATES
OF THE NUMBER OF DRUGS COVERED BY PRIVATE
private prescription drug plans and public drug plans AND PUBLIC PLANS, VERSUS ACTUAL AVERAGES
cover close to the same number of medications. Plan
PLAN MEMBERS PLAN SPONSORS
members estimate that private plans cover about 6,600
drugs and public plans cover approximately 6,500 7,456 7,183
drugs. Plan sponsors estimate approximately 7,500 6,610 6,520
drugs for private plans and about 7,200 for public plans.
• Expressed another way, 61% of plan sponsors believe
that private and public plans cover about an equal
number of drugs, 21% believe private plans cover Private plans Public plans Private plans Public plans
more drugs and 18% believe that public plans cover
more drugs.
ACTUAL AVERAGES*
• Data from the Canadian Life and Health Insurance
*Source: Canadian Life and Health
~11,000 ~5,000
Association, meanwhile, indicates that private drug Insurance Association
Private plans Public plans
plans cover between 10,000 and 12,000 drugs, while
public plans cover between 2,000 and 8,000, for an BASE: All plan members (N=1,505); All plan sponsors (N=403)
average of 5,000.
PLAN MEMBERS PLAN SPONSORS
Confusion over Pharmacare
• Forty-two percent of plan members and 22% of plan LEVELS OF SUPPORT FOR A NATIONAL
PHARMACARE THAT WOULD…
sponsors report not knowing anything at all about a
n Plan members n Plan sponsors
possible national Pharmacare program in Canada.
Plan members are most likely to describe their level Fill gaps in coverage for Canadians
who have no insurance or who 87%
of knowledge as low (35%), while the majority of
are underinsured. The workplace 84%
plan sponsors (40%) describe their level of knowledge plan would not be affected.
as medium.
In some instances, take over or add
coverage to the workplace plan, i.e., for
84%
LOUIS KERBA • DESJARDINS INSURANCE very high-cost and rare disease drugs,
or when total costs are so high that 85%
“The primary role of group members cannot afford to pay their part.
insurance is to ensure plan Fill gaps in coverage for Canadians who
members’ peace of mind regarding have no insurance or who are underinsured, 67%
even if it means that coverage from the 75%
their health and wellness. Private insurers are workplace plan may be reduced.
ideally positioned to proactively design the
Replace all current provincial and
right combination of drug coverage and workplace drug plans to ensure everyone 57%
healthcare benefits that continuously meets gets the same coverage. Workplace drug 72%
plans would no longer exist.
the specific and evolving needs of the
working-age population.” BASE: All plan members (N=1,505); All plan sponsors (N=403)
16 THE SANOFI CANADA HEALTHCARE SURVEY | 2019 CANADA’S PREMIER SURVEY ON HEALTH BENEFIT PLANSCHRISTINE POTVIN • SUN LIFE FINANCIAL • Seventy-one percent of plan members would like to understand
more about national Pharmacare and its possible impact on their
“There is a value proposition
workplace health benefit plan, climbing to 80% among those in
around holistically supporting
poor health, and 80% among those with drug plan maximums.
health, and that’s more easily • Fifty-nine percent of members are concerned about national
achieved when we keep all benefit Pharmacare’s potential impact on their workplace benefit plan.
lines together. If the government • When asked to consider four possible scenarios for Pharmacare,
manages drug coverage exclusively, both plan sponsors and plan members support the two options
we may lose the opportunity to that do not affect the workplace drug plan, or that help the
fully leverage data to illustrate the workplace plan in certain situations.
gaps and proactively respond to • Interestingly, however, plan sponsors are also relatively supportive
trends in chronic disease with early, of two options that would reduce or eliminate coverage by private
personalized interventions.” plans. Plan members are less supportive of these options, though
still somewhat supportive (see chart, page 16).
CLOSER LOOK: PHARMACARE
IMPLICATIONS OF NATIONAL PHARMACARE FOR PRIVATE DRUG PLANS
A national Pharmacare program in Canada will take sponsors also support models that reduce or eliminate
years, and likely multiple governments, to implement. coverage from private plans.
What role will the providers of private drug plans— The mixed opinions likely reflect the misconception
which currently pay for approximately one-third of all that employers will be able to shift the costs of their drug
prescriptions—have in its evolution? benefits onto a national Pharmacare plan, says Brett
In June 2019, the Liberal government’s Advisory Skinner, health policy analyst, CEO and founder of the
Council on the Implementation of National Pharmacare Canadian Health Policy Institute (CHPI). “Employers
released its final report with a recommended model betting on a free ride are in for a rude awakening. The
for a Pharmacare program. However, nothing will be federal government has already signalled that it would
determined until well after the federal election this fall. levy taxes on employers to fund the program. Under a
What also continues to remain unclear is whether or single-payer Pharmacare, they will bear the responsibility
not private drug plan providers will eventually have—or for costs they no longer have control of.”
demand—a seat at the Pharmacare table. Many employers, and most Canadians, also aren’t
And if provisions are made for input from the private yet aware that a single-payer Pharmacare would
sector, what would its position be? Two national fund fewer drugs than today’s private plans, and that
representative bodies—the Canadian Chamber of coverage for new drugs may take more than a year to
Commerce and the Canadian Life and Health Insurance kick in. “A single-payer program would reduce access
Association (CLHIA)—have been advocating for a “fill- to medicines for employees, which could impact health-
the-gaps” approach that builds upon the existing blend related labour productivity and create unintended costs
of public and private drug plans, rather than a single- for employers,” says Skinner.
payer approach that would replace private plans. In its “Close the Gaps” report, released in April 2019,
Opinions at the grassroots level are enlightening. CHPI analyzed the estimated costs, savings and impacts
A survey of members of the Canadian Federation of three possible models for Pharmacare. Like CLHIA
for Independent Business (CFIB), for example, and the Chamber of Commerce, it supports a fill-the-
found that 35% supported a publicly funded national gaps approach. “Federal and provincial governments
drug insurance program, 44% did not and 20% should focus on fixing the drug coverage gaps caused by
were undecided.1 formulary exclusions in existing public plans. A single-
The 2019 edition of The Sanofi Canada Healthcare payer, government-managed drug plan is unnecessary,
Survey also uncovered conflicting views (see page 16). dangerously disruptive and costly,” states Skinner.
While support is strongest for Pharmacare models that
1. M
embers’ Views at Work. Results of Mandate 268. Canadian Federation for Independent
incorporate existing private plans, well over half of plan Business. 2017. Accessible at https://www.cfib-fcei.ca/sites/default/files/pdf/268_ON.pdf.
CANADA’S PREMIER SURVEY ON HEALTH BENEFIT PLANS THE SANOFI CANADA HEALTHCARE SURVEY | 2019 17Drug plan use and estimated spend DANIELLE VIDAL • SSQ INSURANCE
• In 2018, 82% of plan members submitted at least one personal “The optimal use of drugs
claim for a prescription drug and 62% submitted at least one for to treat chronic conditions
others covered by their plan.
needs to come before
• Plan members report submitting an average of 8.0 claims for
conversations about coverage for
themselves and 7.7 claims for others. Personal claims are most
higher-cost drugs. Awareness of the
frequent among those in poor health (13.9) and those who regularly
take three or more medications (14.8).
impact of non-adherence appears
• When asked to estimate how much their workplace drug plan to be growing, but as an industry, we
paid for prescriptions in the past year, members estimated can raise more of an alarm so that this
$2,393 for themselves (about $299 per claim) and $2,445 for becomes a priority for action.”
others ($311 per claim). The personal estimate climbs
to $4,771 among those taking three or more medications. KEY TAKEAWAYS
• Four percent of plan members estimate their plan spent more
than $10,000 for prescription drugs. When those claimants + Plan members significantly underestimate
are removed, the annual estimates are $1,182 for personal the number of drugs covered by their
prescriptions ($148 per claim) and $732 for others ($103 per claim). private drug plan and believe the number
is comparable to provincial drug plans.
• Among plan sponsors, 48% are concerned that improper medication
What’s more surprising, however, is that
use negatively impacts the cost of their drug plan. The level of concern
the majority of plan sponsors also believe
is highest among employers with 250 or more employees (65%) and
that private and public plans cover an equal
in Quebec (65%). As well, plan sponsors who receive analyses of
number of drugs.
their top disease states (60%) are more likely to be concerned.
+ The advisory board agrees that the results
Preferred pharmacy networks (PPNs) regarding national Pharmacare are a wake-
• Sixty-three percent of plan sponsors think it would be very up call, due to the low levels of understanding
inconvenient for plan members to fill prescriptions at certain among both plan members and plan
pharmacies requested by the health benefit plan (otherwise, sponsors. The lack of understanding—and
members might have to pay more out of pocket). Twenty-five possibly a general sense of confusion—is
percent think it would be somewhat inconvenient. also made apparent by the results indicating
• Plan members, meanwhile, feel less strongly: 43% think it would be that respondents appear to support multiple,
very inconvenient and 36% somewhat inconvenient. Twenty-one and very different, scenarios for a potential
percent indicate it would not be at all inconvenient. Interestingly, these Pharmacare.
results do not differ much among those in poor health (49%, 33%,
18%) or those who take three or more medications (47%, 32%, 21%). + It appears that plan members and plan
sponsors do not fully understand the
• Twenty-two percent of plan sponsors report having a preferred
advantages of private drug plans over public
pharmacy network in place, increasing to 37% in Atlantic Canada
plans. Plan sponsors who support national
and 31% among employers with 250 or more employees.
Pharmacare replacing private plans may not
fully understand that they will have to cover
PLAN MEMBERS
the costs somehow, likely through higher
AVERAGE NUMBER OF PERSONAL CLAIMS FOR taxes. They also may not understand the
PRESCRIPTION DRUGS IN THE PAST YEAR
ramifications of losing control over benefits
that are highly valued by plan members,
and which directly affects productivity,
absenteeism and overall morale.
8.0 9.6 13.9 14.8
Overall With chronic
disease
In poor
health
Taking three or
more medications
+ Small employers are much less
concerned than mid-size and large
employers about the negative impact of
$2,393 4% non-adherence on drug plan spending,
Plan members’ estimate of Plan members who estimate
how much their plan paid for prescription-drug costs of more suggesting the need for new approaches to
personal prescriptions last year than $10,000 last year raise awareness about the level and effects
of non-adherence.
BASE: All plan members (N=1,505); Size of subgroups varies
18 THE SANOFI CANADA HEALTHCARE SURVEY | 2019 CANADA’S PREMIER SURVEY ON HEALTH BENEFIT PLANSYou can also read
