Cost management

Taking an optimal approach to health management is a good way to ensure your plan remains sustainable. We offer efficient solutions that help you balance employee health and the financial health of your organization.

Here are some of the drug cost-control measures we offer—most require a direct payment card.

Some of the solutions in this section are automatically included in our drug insurance coverage, while others are offered as add-ons. Talk to your group insurance advisor to find out more.

Plan member education

We think it’s important for plan members to understand the impact their drug purchase decisions have on plan costs, so we’ve posted this information online. Learn more about plan member education

Drug utilization review program

Allows pharmacists making point-of-sale electronic transactions to identify possible irregularities when filling a prescription, such as:

  • Dangerous drug interactions
  • Repeat drug purchases at multiple pharmacies
  • Improper use of a drug (including overuse)
  • Inappropriate supplies
  • Can reduce drug claim costs by 2% to 3%1.

Integration programs

Ensures that your plan doesn’t pay for drugs that should be covered by a provincial or hospital plan.

  • Can reduce drug claim costs by 1% to 2%1.

Prior authorization drug program

Ensures that plan members receive the most suitable and cost-effective treatment.

  • Can reduce drug claim costs by 1% to 2%2.

Generic substitution

Generic drugs can cost between 35% and 70% less than their brand name equivalents, so we recommend making generic substitution mandatory. This means that reimbursements are calculated based on the cost of the least expensive generic equivalent available.

  • Can reduce drug claim costs by up to 4% (if combined with a pharmacy mark-up and dispensing fee cap)2.

Tiered plan with dynamic therapeutic formulary

This plan offers two levels of reimbursement for prescription drugs, which encourages plan members to choose equally effective, lower-cost drugs while ensuring that they still have access to other prescription drugs covered by their plan.

  • Can reduce drug claim costs by up to 7%2.

Active Pharmacy

Maintenance drugs for chronic diseases such as asthma, diabetes, high cholesterol and high blood pressure account for more than 50% of drug claims.

Active Pharmacy can reduce maintenance drug expenses by encouraging plan members to make more cost-effective choices.

  • This solution is not available in Quebec.
  • Can reduce maintenance drug expenses by up to 10%.

Patient support program for specialty drugs

This program is designed to make things easier for plan members with complex illnesses. It brings together all the services they might need to deal with their condition and achieve the best possible treatment results, including 24/7 confidential telephone support from a pharmacist.

And it doesn’t just make their lives easier—it also improves treatment adherence and productivity, reduces absenteeism and lowers the risk of disability.

  • This program is included with all drug insurance plans with at least one plan member outside of Quebec. Quebec residents are not eligible.

360° Drug cost simulator and pharmacy finder

This tool is available on the secure site for plan members and the Omni app. It shows plan members how drug prices can vary and actively promotes the use of generic drugs. It’s a great addition to our other cost-control measures.

1. Based on data from Express Scripts Canada.

2. Based on our estimates.