HBT Trends in Dental and Extended Health Care Usage

Leza Muir, Senior VP Claims ServicesDiana Pengelley, Account Manager

Joanne Jung, Pharmacy Services Manager

Items to address

Benefit Plan Designs

Drug Trends

Pharmaceutical Landscape Update

Dental trends

EHC trends

Issues to Consider

Healthcare Benefit Plans in British Columbia

Dental Plans

PUBLIC SECTOR PRIVATE SECTOR100% Basic60% Major 50% Orthodontia

80% Basic50% MajorOrthodontia seldom offered

Includes adult orthodontia Adult orthodontia rarely offered

Unlimited maximums Annual maximum to $1500 combinedLimited cost sharing (if any) under collective agreements

Cost sharing

Extended Health Care Plans

PUBLIC SECTOR PRIVATE SECTOR100% EHC plan 80% reimbursement

Unlimited lifetime maximum $500,000 lifetime maximum

Unlimited paramedical practitioners $500 annual paramedical limit

No annual drug limit Dispensing fee caps or Rx deductibles are becoming popular

Vision care maximums over $300 every 2 years

Vision care $200 every 2 years

Drug Trends – Pharmaceutical Landscape

HBT Specific Claims Experience

Top Therapeutic ClassesTop DINsTrends

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

CARDIO BIOLOGIC GI MENTALHEALTH

HBT TOP THERAPEUTIC CATEGORIES (Top 100 DINs)

200820092010

HBT Specific Top 10 DINs

2009DIN Claims Paid

Nexium 40mg $1.35 MRemicade 1.3 M Lipitor 10mg 1.0 MLipitor 20mg 980 KHumira 860 KEnbrel 780 KCrestor 10mg 750 KPMS-Valacyclovir 560 KOne Touch Test Strip 550 KCipralex 10mg 500 K

2010DIN Claims Paid

Nexium 40mg $1.47 MRemicade 1.35 M Crestor 10mg 874 KEnbrel 867 KHumira 832 KCipralex 10mg 645 KPMS-Valacyclovir 615 KCymbalta 578 KLipitor 10mg 577 KLipitor 20mg 576 K

Generic – May 2010

BC Government Pharmacy Services Agreement

The impact so far…

11

BC Government Pharmacy Services AgreementBefore Agreement Oct 15, 2010 July 04, 2011 Apr 02, 2012

Existing Generics

65% (average) 50% 40% 35%

New Generics (launched since Nov 2008)

50%- 70% 42% 40% 35%

*Generic Drug Prices relative to Brand Prices. Applies to drugs on PharmaCare formulary only.

Before Agreement July 28, 2010 Oct 15, 2010 July 4, 2011 April 2, 2012

Maximum Dispensing Fee $8.60 $9.10 $9.60 $10.00 $10.50

Drug Mark-Up 7% 8%

12

What could have happened?

Substitute drugs Continue to dispense brand name drugs rather than

generic drugs covered by PharmaCare Dispense generic drugs that are not covered by

PharmaCare

Shifting costs Increase mark-up on ingredient cost Increase dispensing fees

13

PBC Generic Replacing Brand – Claims Paid

PBC Generic Replacing Brand - Claims Volume

15

PBC Total Cost Analysis

16

PBC Dispensing Fees

17

PBC Brands vs. Generics

18

PBC Generic Drugs Only

Dental Trends

HBT Dental Claims Paid by Plan

$0.00

$10,000,000.00

$20,000,000.00

$30,000,000.00

$40,000,000.00

$50,000,000.00

$60,000,000.00

$70,000,000.00

$80,000,000.00

$90,000,000.00

Plan A - Basic Plan B - Major Plan C - Ortho

Dental

Cla

im P

aid

Am

ount

2008

2009

2010

HBT Dental Claims Paid by Cost Category

$0.00

$5,000,000.00

$10,000,000.00

$15,000,000.00

$20,000,000.00

$25,000,000.00

$30,000,000.00

$35,000,000.00

$40,000,000.00

Diagnostic Preventive Restorative Endodontics Periodontics Dentures Bridges Oral Surgery Orthodontics Other

Dental

Cla

im P

aid

Am

ount

2008 2009 2010

Extended Health Trends

HBT EHC Claims Paid by Cost Category

$0.00

$10,000,000.00

$20,000,000.00

$30,000,000.00

$40,000,000.00

$50,000,000.00

$60,000,000.00

$70,000,000.00

Drugs Paramedicals Vision Care Medical Aids /Equipment

Out of Province Other

EHC

2008 2009 2010

HBT EHC Claims Paid Increase by Cost Category

$1,014,270.01$3,766,682.00

$1,493,834.16

($110,966.46)

($102,720.20)

$186,686.50

Drugs

Paramedicals

Vision Care

Medical Aids / Equipment

Out of Province

Other

2010 EHC Claims Paid vs. 2009 EHC Claims Paid

HBT EHC Claims Paid by Paramedical Category

$14,412,617.78

$2,355,824.01

$5,858,719.00

$539,320.64

$671,274.14

$506,354.35

$250,336.47

$25,801.55

$2,213.36

Massage Therapy

Chiropractic

Physiotherapy

Psychology

Acupuncture

Naturopathy

Podiatry

Speech Therapy

Homeopathy

Other

Issues to Consider

PBC - Cost Containment Features for HBT

Reasonable & Customary charges for paramedical practitioners LCA-RDP (generic) drug pricing on some plansAudits of excessive usage Offer Blue Advantage

Blue Advantage

Adds even more value to your benefits. Offers savings on medical and vision care

products and services, but also many other products and services offered by participating providers across Canada. Blue Advantage is one more reason why Blue

Cross is the most trusted name in benefits for your employees

Excessive Usage

When fraud or abuse occurs, your benefit plan costs rise, which means higher plan premiums for consumers—for British Columbians like you. Individual plan members and group plan

sponsors must ultimately pay every dollar of fraud or plan abuse. Regular profilingAudits

HBT Cost Containment Potential Savings

HBT Cost Containment Potential Savings

$28 M

$20 M

$1.9 M

$1-3 M

???

Issues to Consider

Future Sessions

“Take Aways”

What issues would you like addressed in the future?

Thank you