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
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
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
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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%
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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
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
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
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