Great-West Life introduces the SMART drug plan
In June 2017, Great-West Life is introducing the SMART drug plan, aiming for Sustainable, Managed and Reasonable Treatment. Like Manulife’s DrugWatch, SMART will bring more rigourous review to selected new drugs and indications and likely delay product entry into its formularies. Great-West Life indicates its reviews will not only rely on the Canadian Agency for Drugs and Technology in Health (CADTH). As Great-West Life noted, CADTH assessments consider the needs and perspectives of the health care system and not the impact of drug products on productivity-related costs such as absence, disability and presenteeism that matter to employers.
Great-West Life is one of the three largest national insurers, holding about one-fifth of the private health market. It administers drug plans that spend over $2 billion annually on prescriptions, considerably more than any province except Ontario. SMART is positioned as a coordinated, more intense review of certain high-cost drugs to ensure greater value for employer spending. The announcement material did not include detail on the drug selection criteria or the assessment timeframe.
The insurer describes its review as “from every angle and considering factors that include alternate treatment options, side effects, safety, cost effectiveness and the stage or progression of the disease” within its approved indication(s). Great-West Life will use independent consultants to conduct an “unbiased” assessment of clinical and cost effectiveness, as well as TELUS Health (its Pharmacy Benefits Manager) and its own internal pharmacy team.
There are three potential outcomes:
- Listing with claims management, or
- Exclusion from coverage.
SMART claims management may include step therapy, lower cost alternative therapies, coordinated reimbursement with other private and public drug plans and patient support programs, as well as Great-West Life’s mandatory health case management services.
Described as less onerous than a managed formulary, SMART is intended to ensure prescription drugs are appropriately prescribed, that payers get financial value, and that patients using more complex therapies are better managed.
We have been advised that Great-West Life will schedule a webinar for the pharmaceutical industry in late June to provide additional information on their new program.
MORSE would like to thank Chris Bonnett of H3 Consulting for leading the preparation of this important update.
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