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Evolution of networks for private payers

Evolution of networks for private payers

JANUARY 2014 – Canada’s largest insurance company is working “with pharmacists in new and exciting ways,” Barb Martinez, National Practice Leader at Great-West Life, told attendees at the Canadian Foundation for Pharmacy’s recent Pharmacy Forum event.

Pharmacists are ideally positioned to help insurers “meet the needs of a dual bottom line: the cost management needs of the plan sponsor and the health management needs of the plan member,” said Martinez. Preferred (or pharmacy) provider networks (PPNs) serve as the starting point, and they come in many shapes and sizes. For example, more than 1,800 of Great-West Life’s clients have adopted a drug plan that includes a PPN with Costco Pharmacy. While the aim is largely cost containment, the network also promotes Costco’s health programs and other offerings such as flu shots.

On another front, Great-West Life is partnering with Shoppers Drug Mart for diabetes support. Plan members can sit down with their local participating Shoppers Drug Mart pharmacist to do an A1C test and get advice on adherence and lifestyle changes. Follow-up appointments are available for those with suboptimal test results. The insurer and Shoppers Drug Mart are also piloting a therapeutic substitution program for hypertension medications.

In addition, Great-West Life’s Health Case Management program for 13 higher-cost specialty drugs includes a network of about 1,200 pharmacies from all pharmacy formats. Plan members with prescriptions for these drugs must go to one of these pharmacies, and case managers help support adherence and outcomes, as well as help members navigate coverage and the healthcare system. Health Forward, a division of AmerisourceBergen, manages the pharmacy network.

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