GROUP INSURANCE

OUR OFFER

PharmAssist includes, as a standard offer, an elaborate set of solutions regardless of the plan size. We also have a full range of additional solutions available to allow our clients to implement the best possible plan, always based on their specific needs. A simple, flexible and affordable approach!

Standard in all of iA Financial Group’s drug insurance plans

A strong foundation to build on:

Drug card

Main benefits

  • Allows the implementation of all our cost control solutions.
  • No form to be completed (except for drugs requiring a prior authorization).

Our drug cards allow a direct or deferred processing of claims at the point-of-sale and give access to a sophisticated claim adjudication system from our partner, Express Scripts Canada.

Drug utilization review program

Main benefits

  • Reduces the risk of adverse drug interactions for plan members.
  • Prevents plan expenses by limiting duplicate therapies and early renewals.

Each time a plan member has a prescription filled, anywhere in Canada, Express Scripts Canada’s adjudication system analyses it to identify potential drug therapy problems. If any, the system immediately notifies the pharmacist, who can then discuss the issue with the plan member or attending physician.

Standard reasonable and customary fees limits

Main benefit

  • Controls plan costs by limiting pharmacists’ mark-up and dispensing fees.

This measure ensures that submitted costs for eligible drugs remain reasonable and ensures a fair sharing of expenses between the member and the plan. The limitations applied reflect the trend in prices observed in each province.

Direct coordination of benefits

Main benefits

  • Ensures that your plan is not the first payer for drugs covered under another private or public plan.
  • No administrative processing required for a member with multiple coverage.

Direct coordination of benefits helps plan members covered under two plans to maximize both insurance policies. The coordination is processed automatically at the point-of-sale. A pay-direct drug card is required.

Management of dynamic maintenance drugs

Main benefit

  • Optimizes supply duration.

Management of dynamic maintenance drugs allows any drug to be considered as a maintenance drug if it is taken regularly over a specific period of time. Therefore, this helps limit the frequency at which a drug is purchased and reduces wasted expense on extra dispensing fees.

Hospital drug program

Main benefit

  • Ensures that drugs administered at the hospital are not reimbursed by private plans.

Drugs administered in a hospital or external clinic require specific care and most are covered under provincial healthcare plans. The list of drugs included in this program is managed on a monthly basis by the Express Scripts Canada clinical team.

Product listing agreements with manufacturers

Main benefit

  • Generates immediate savings for members and their plan (reduced drug price automatically applied at the pharmacy).

These agreements grant access to certain drugs at a preferred rate negotiated by our partner, Express Scripts Canada. Based on the agreed-upon terms and conditions, plan members benefit from a discount for each drug included in the program. This solution is not available in Quebec.

Prior authorization process

Main benefit

  • Ensures smart use of complex or expensive drug therapies.

Prior authorization is a very effective method to manage the costs of complex or expensive drugs. The reimbursement of certain drugs is approved only when optimal criteria for coverage are met. This ensures that the plan pays only for the most appropriate and cost-effective treatment.

To review our list of drugs requiring prior authorization, click here.

Drug evaluation process

Main benefit

  • Helps understand the risk covered and anticipate market trends.

Our drug evaluation process allows us to quickly identify new drugs on the market that could potentially compromise the viability of group plans. A team of highly qualified professionals evaluates the financial risk associated with such drugs and establishes optimal coverage strategies.

Fraud detection and prevention program

Main benefits

  • Prevents plans from reimbursing unjustified expenses.
  • Provides an analysis and a fast and efficient intervention from iA Financial Group, when required.

As a member of the Canadian Health Care Anti Fraud Association (CHCAA) and a participant in the Express Scripts Canada special audit program to ensure the integrity and accuracy of health claims, we are continually working at implementing the best possible controls to prevent any unjustified expense.

Additional Solutions

The first steps on the way to reducing drug costs

Essential solutions to get fast and tangible results

Generic substitution

Main benefit

  • Fosters optimal plan management by limiting the reimbursement of interchangeable drugs to the price of their lowest-cost equivalent.

Generic drugs are copies of brand name drugs approved by Health Canada and available at a much lower price. Generic substitution is easy to implement in a drug insurance plan and will prompt plan members to select the lowest cost alternative.

Plan members’ contribution to drug costs

Main benefit

  • Increases plan members’ awareness about drug costs.

Sharing drug costs with plan members helps preserve the plan’s viability, while promoting smarter expense habits. Different methods of cost sharing can be implemented such as annual maximums, deductibles or a coinsurance.

Tiered plans

Main benefit

  • Allows savings for the plan by promoting lower-cost alternatives.

A tiered plan provides various reimbursement levels. The portion of total costs assumed by a plan member increases from tier to tier. This type of plan provides great flexibility, since different tiers can be implemented based on drug formularies or types, claimants, and even suppliers.

Dispensing fee limits

Main benefit

  • Allows savings for the plan by limiting recurrent expenses.

This measure limits pharmacists’ dispensing fees in two ways: frequency and price. A frequency limitation defines the maximum number of times dispensing fees are reimbursed each year. A limitation on price sets a maximum dispensing fee amount for each drug purchased. This solution is not currently available in Quebec.

Leveraging tighter plan management

Solutions to meet specific needs

Managed formularies

Main benefit

  • Enables the reimbursement of drugs that offer the best cost-effectiveness ratio.

The Dynamic Therapeutic Formulary (DTF) is a list of drugs managed by the Express Scripts Canada clinical team that defines which drugs are reimbursed by the plan. The formulary is reassessed each month. The DTF includes two tiers that prompt plan members to select the treatment providing the best reimbursement, while having access to other options.

Therapeutic substitution

Please contact an iA Financial Group Account Executive to inquire whether this option may apply to your group.

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Step therapy

Please contact an iA Financial Group Account Executive to inquire whether this option may apply to your group.

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The Active Pharmacy

An innovative solution to manage chronic and complex health conditions

Main benefits

  • Allows plan members to benefit from customized and efficient pharmaceutical support for their specialty and maintenance drugs.
  • Proposes preferred dispensing fees and mark ups fostering tight cost management.

The Active Pharmacy, an initiative of Express Scripts Canada’s pharmacy, is the ideal solution to efficiently manage the drug categories that are most likely to negatively impact the financial health of group plans. The Active Pharmacy team works closely with plan members to manage expenses, improve care and make them aware of the importance of treatment adherence.

You have plan members in Quebec? Please contact an iA Financial Group Account Executive to know how your plan members can benefit from the Active Pharmacy through the PharmaGO Network.

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