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Is medication therapy management the new disability case

management? There’s mounting data to show that pharmacists

have an influential role to play in helping plan members stay

healthier when on medications. For plan sponsors, that means

better adherence, increased productivity, fewer sick days and,

in the long term, overall cost savings.

Despite this potential, the benefits industry has yet to

embrace medication therapy management because of a lack of

awareness on how to communicate its value, price it and pay

for it. Ten industry players gathered to discuss the best ways to

move medication therapy management forward so members

and sponsors can benefit from this important service.

Paying for medication therapy management

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thank you to our Pharmacy benefits Roundtable participants(Back row, l-r) Tim Clarke, chief innovation officer, aon hewitt; Johnny Ma, president, mapol inc.; Martin McNeil, senior manager of external relations, astraZeneca; Dr. Alain Sotto, chief physician of Ontario Power Generation and toronto transit commission; Paula Allen, vice-president of research and integrated solutions, morneau shepell.(front row, l-r) Leanne MacFarlane, senior director of business development, mhcsi managed health care services inc.; Judith Plotkin, senior vice-president of business development, homewood human solutions; Cindy Dyer, senior manager of operations, mhcsi managed health care services inc.; Lorilee Pontone, private healthcare manager, abbVie; Christine Than, pharmacist and drug-solutions specialist, aon hewitt; Laureen Rance, pharmacist, teLUs health.

Plan sponsor reaction to medication therapy management the idea of medication therapy manage-ment has been around for years, and it’s starting to gain more traction with plan sponsors, insurers, consultants and other industry stakeholders.

“i think people are starting to appreci-ate the fact that there needs to be more patient support, as well as support that actually helps with drug plan manage-ment costs,” says Paula allen, vice-presi-dent of research and integrated solutions at morneau shepell in toronto. “the main issue with medication therapy manage-ment right now is that plan sponsors do not generally understand the specifics of what is involved and what the benefit is, so it is not on the radar. Plan sponsors do care about making sure issues get managed. so you know, if the issue is depression, they want to know how it is being managed, what is the employee experience and if is it worth the effort to implement it.” to get plan sponsors to pay attention to medication therapy management programs, they need to be discussed in an issue-focused way.

Johnny ma, president of mapol inc. in mississauga, Ont., agrees that plan sponsors don’t clearly understand the benefits of medication therapy manage-ment. “awareness is also required,” he says. “they can certainly understand the concept, but i’m not sure if they know

what they’re going to get into with this initiative and what the return is for their organization or benefits plan.”

Lorilee Pontone, the private health-care manager at abbVie in mississauga, believes that most plan sponsors would be enthusiastic about programs that improve health outcomes and poten-tially lower costs in the long run, so what they really need to understand is how it can be paid for. “the question is, in the funding model, how will you fund those extra services? i don’t think any employer would blindly say sign me up for another cost,” she says.

tim clarke, chief innovation officer at aon hewitt in toronto, says employers are open to the conceptual idea of case management—just look at how disabil-ity claims have evolved over the past 25 years. medication therapy management is a type of case management that could become a normal practice in a few short years. it could work like other paramedi-cal practitioners, such as a chiroprac-tor or a massage therapist, who can be reimbursed for their services up to a maximum each year. “Plan sponsors are understanding of the concept but not the details,” says clarke. “they’re not quite sure how we get from here to there with funding, the process and understand-ing who’s going to do it most efficiently. Ultimately, i think pharmacies must take the initiative to come forward with the ser-vices they want to offer, promote their

value and clarify those details to make it easy for employers to understand.”

Create a demandif plan sponsors are open to medication therapy management, what do they need to do to take the next step and embrace it? Laureen rance, a pharmacist with teLUs health in toronto, says they need to see the connection between the posi-tive impact on their organization for any payments they make.

“i don’t think we’ve connected the dots yet for regular plan sponsors to think about things in terms of prevention, adherence and how that can impact their businesses,” says rance. “if the outcome they want is fewer people getting sick or being absent or going on disability, i don’t think we’ve clearly shown the chain of events and the more effective ways they can invest their money.”

morneau shepell’s allen says that right now the best way for plan sponsors to understand medication therapy manage-ment is to see it in action. “a clear example of this is flu shots being given in pharma-cies,” she says. “People saw and experi-enced it, and now they appreciate it.”

another way plan sponsors will pay more attention to medication therapy management is when employees are coming to them and asking for reimburse-ment on the services their pharmacies provide. “right now, pharmacists aren’t broadly offering the services and therefore aren’t creating a demand from patients,” says clarke. “if an individual doesn’t see the value and isn’t asking for these ser-vices, then why would their employer?”

ma suggests a simple product offering that plan sponsors can say yes or no to might be a good place for pharmacies to start.

What’s the product offering? What would medication therapy manage-ment look like if it were a product? allen says a good place to start is with the out-standing questions about any potential product. some considerations are straight-forward, while others are not. “is it avail-able across the board or only to targeted

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i think people are starting to appreciate the fact that there needs to be more patient support, as well as support that actually helps with drug plan management costs.—Paula Allen, Morneau Shepell

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conditions? if the member doesn’t want to participate, is that an option or a fail-ure point? are we just supporting people who don’t need support? What happens if people don’t do what they need to do while in the program? how does it get paid? is it part of your markup? is it part of some-thing else?”

in addition to those questions, clarke says that any product must be simple and easy to understand. “We’re talking about value added, which isn’t compel-ling to an employer without the details. We’re using these vague terms that aren’t tactical. Pharmacists need to offer spe-cific services that deliver outcomes that employers want,” he says. “for example, a pharmacist could offer to do a medication review for $60 for any employee taking more than three medications. if the phar-macist can also articulate the expected outcome of this intervention, such as X% of employees will have better adherence, y% will require fewer prescriptions and Z% will have fewer absences from work, this could be a compelling business case for an employer.”

“that type of offer is short, sweet and easy for someone to understand. now they can make an informed decision, do i like it or not?” clarke continues. “Phar-macists need to give plan sponsors the

simplest version of what their return on investment will be. What will happen? What kind of change in treatment? What does that mean to the sponsor? how are the sponsor’s employees healthier because of it? if pharmacists can take the term ‘value added’ to the next sentence or two, they’ve got a strong business case.”

martin mcneil, senior manager of exter-nal relations at astraZeneca in toronto, says this is especially true for smaller employers who prefer not to get deeply involved with personal healthcare deci-sions. the rOi proposition must there-fore be very strong. “the decision-making

process at renewal time is usually focused on premiums or budget,” he says, “so the opportunity to consider value beyond what’s on the table is often not there.”

Judith Plotkin, senior vice-president of business development at homewood human solutions in toronto, says phar-macists and those developing the medi-cation therapy management products should remember that some employers have very diverse populations or employ-ees in remote areas, which could make these programs difficult to participate in. “if it’s offered as a product through one chain, it’s a little more difficult,” she

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For pharmacists, there is an added value to sitting down with patients, says Christine Than, a pharmacist and drug-solutions specialist at Aon Hewitt and a part-time retail pharmacist in Montreal. “To counsel patients and understand what’s going on with their health and their ability to follow a therapy is what pharmacists are trying to do,” she says.

Laureen Rance, a pharmacist with TELUS Health in Toronto, agrees that having a pharmacist involved is key but adds that pharmacists need more information. “The pharmacy community is still without access to critical information such as diagnosis and lab results. Until we cross that boundary and get that solved, we’re working with half the deck,” she says, adding that until pharmacists get quick access to as complete a patient profile as

possible, it’s going to be challenging for them to be as effective as they can be.

Change is needed, says Tim Clarke, chief innovation officer at Aon Hewitt in Toronto. “The relationship between pharmacy and plan sponsors is evolving. Historically, pharmacists and pharmacy were viewed as simply a prescription-dispensing service, and they were paid for that service,” he says. “If pharmacists truly want to be a partner, they need to work with plan sponsors, which will take both a change in behaviour and a shift in attitudes.”

For pharmacists to offer services that help shift attitudes, they require appropriate funding. One piece of this puzzle is determining the funding model to allow pharmacists to do the unique work necessary to help patients and their employers.

the pharmacy perspective

Pharmacists need to give plan sponsors the simplest version of what their return on investment will be.—Tim Clarke, Aon Hewitt

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says. “But if it’s offered as a professional service, it’ll be easier for employees to participate.”

Ultimately, plans sponsors will take notice of medication therapy manage-ment services when they demonstrate a convincing rOi for employers or be so valuable to individual employees that it becomes a service offered because it’s a differentiator for employers in terms of perks, recruitment and engagement.

Partnering for changeDr. alain sotto, chief physician of Ontario Power Generation and toronto transit commission and an occupational medi-cal consultant, sees an easy opportunity for doctors and pharmacists to partner to demonstrate the value of medication therapy management and the impact it can have on plan sponsors.

“the greatest single thing that pharma-cists could also offer as a service is check-ing to see that physicians are adhering to most of the medical health guidelines in canada,” says sotto. “for example, the lat-est canadian Diabetes association guide-lines state that if your three-month-average blood sugar as measured by hemoglobin a1c is over 8.5%, your doctor needs to add another drug to make sure that he or she is compliant and ensure that you get the best health outcomes to avoid future diabetic complications. Do all physicians follow it and adhere to it? not likely. that could be something pharmacists could sell.”

in fact, doctors could even write a prescription for a medication review and advise their patients to have it done. “i could write a referral that says please review medications to adhere to cDa guidelines and make sure i’m giving the patient the right medications given his or her age, health, kidney function, etc.,” says sotto.

Patients could then ask their employ-ers to cover this cost or use an existing health-spending account to cover it. if plan sponsors could then see the benefit of ensuring that patients are on the right medications for their conditions and how that impacts absenteeism, productivity and disability, pharmacy would be much closer to having medication therapy man-agement as a covered service.

Other industry players keen on medi-cation therapy management are the phar-maceutical companies. mcneil says they are interested in adherence and compli-ance data because it supports the value and importance of medications for plan sponsors. “the most expensive medicine is one that is not taken,” he says, noting that several initiatives are currently in the works to provide deeper insight into how medicines are working in real-world set-tings. “We are confident that this data will

add significant value for plan sponsors in their discussions with their advisers.”

Paying the billWhen it comes to getting plan sponsors to pay for medication therapy management, allen says making it a product means it must have an rOi, reporting and a clear description of what it is. in the current

environment where most plans are add-ing more of this structure, there is a risk the product will be overlooked if it isn’t convincing as well as understandable.

“Getting something new widely adopted is always an important planning consider-ation. medication therapy management that comes from a doctor’s referral is an interesting concept,” says allen. “When there is referral from a doctor, it’s in the mind of the patient as important. that would address one issue. a second issue is financial. the option of direct payment by the employee or use of their health-spending account could also be consid-ered. if clear value is then demonstrated to both the employee and the employer, employers would be more open to plan design and programming solutions to facilitate access for those in need.”

Once plan sponsors have employ-ees using medication therapy manage-ment, they will be quickly convinced, says Leanne macfarlane, senior direc-tor of business development at mhcsi managed health care services inc. in Dartmouth, n.s. “We’ve had over 1,000 members do a medication review, and we’ve surveyed them afterward,” she says. “Overwhelmingly, they comment on the value of this service and believe it is something that should be covered.”

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i could write a referral that says please review medications to adhere to cDa guidelines and make sure i’m giving the patient the right medications given his or her age, health, kidney function, etc.—Dr. Alain Sotto, Ontario Power Generation and Toronto Transit Commission

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