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Benefit Solutions

For advisors and consultants

Welcome to Benefit Solutions, our online publication for Advisors and Consultants. This publication will bring fresh perspectives to help you and plan sponsors to stay current on health and benefit issues.

We welcome your feedback and suggestions for topics that you would like to see addressed.

Plan Trends

Data-driven insights into what is impacting plan member health and benefits, and our strategies and tools to address and leverage these.


How we are identifying and creating new opportunities to help plan sponsors and plan members take full advantage of their benefit plans.

Maximizing Plan Benefits

Spotlight on one of our benefit solutions.

Plus industry news, reader polls and more

Along with Benefit Solutions, we are also introducing a new publication for plan sponsors and group administrators. Insights on Benefits will cover many of the same topics, but with a focus on the plan sponsor perspective. Look for it soon.

Plan Trends

Drug adherence: Keeping out of the danger zone

It seems simple. The doctor prescribes medication and explains to the patient when and how the drug should be taken, and the health outcome. The patient follows the treatment plan, and the medications do their job.

But in the real world, one of the biggest challenges to better health is drug adherence. Over a recent six-month period (July-Dec 2017) we found that, 40-50% of our plan members claiming for chronic disease medications, do not take their medication as prescribed. And for mental health conditions, the number of non-adherent plan members rises to 60%.

And as more and more high-cost specialty drugs enter the market, and a growing number of plan members are dealing with chronic diseases, every plan member who is not following the prescribed treatment is adding notable costs to the plan without improving health impacts.

Accepting non-adherence as a cost of doing business, or attributing it to basic human nature, is not an option. We need to better understand what plan members who are not following their prescriptions have in common, analyze the root causes of this behaviour, and create measurable strategies to ensure that drugs are being taken as prescribed.

Understanding the challenge

It’s no surprise that most plan members don’t volunteer the fact that they are not following their prescription properly. And the reasons can be as varied as the individual, from misunderstanding prescribing instructions, forgetfulness unwanted side effects, medication cost or even stigma around the condition.

So since self-reporting isn’t necessarily a reliable measure, we’re using our data to get more insight into the problem. We’re using validated adherence measures such as Medication Possession Ratios (MPR) and the Proportion Days Covered (PDC), which use the patients refill record as an indicator of whether they are taking the medication as prescribed. ;

A multi-pronged approach

It’s important to address both sides of the drug adherence challenge:

Upstream - to try and minimize the effects of non-adherence from the onset.

We are committed to leveraging every opportunity to engage plan members in following prescribed drug regimens. For high-cost specialty drugs, for example, our integration with Patient Support Programs provides plan members with the access to the assistance members need.

Integrating counselling and coaching into extended health benefit plans, as with our Managing Chronic Disease benefit, provides easy access to professional supports including adherence education and medication reviews.

Working with a specialty pharmacy partner, we are using predictive modeling to identify those who are at most risk of non-adherence for hepatitis C treatment. These members receive elevated support to ensure adherence. This approach, which is being expanded to other conditions, has resulted in industry-leading adherence to treatments.

Downstream – to identify & mitigate the cost consequences of non-adherence.

Individual adherence data can be used to directly inform future coverage decisions, creating a shared accountability model, ensuring that the right drug is available for the right patient, at the right time.

For example, in assessing Repatha requests, we use a claims data analytic tool to establish if a patient is adherent to their base statins before authorizing coverage for the expensive add-on therapy.

Bottom line

Medication non-adherence erodes the ROI of the health plan investment, and at its core is wasted expenditure and stress on drug plan sustainability. It also means that plan members are not getting the potential health improvements the treatment offers. Watch for continued innovation from us as we continue to find ways to improve member health and plan sustainability.


Digital tools with a purpose

As we all know, modern life is lived online. In fact, for a growing percentage of our population, life before always-on mobile access (let alone the Internet itself) is something they have never known.

We’re harnessing this digital revolution to bring advantages to both plan members and benefit plans.
More than a quarter of a million of our plan members are using their phones to interact with us. Mobile claims have more than doubled over the last two years and the rate of growth continues to escalate.

Today, members can use their phone to find a trusted provider who will submit their claim for them, or submit it themselves through the app. And with instant access to details on their coverage, they can make informed benefit choices.

Online Therapy

But as we saw above in talking about drug adherence, our digital story isn’t only about creating the best possible member experience. By using our data, we can identify and address opportunities to offer tools that will improve member health and returns from plans’ benefit spend.

For example, almost 17% of our total plan member population will claim for drugs primarily used to treat mental illness (- depression and anxiety) over the course of their lifetime. Utilization climbs rapidly in the late teens and is highest for people in their 50s.

Yet only 7% of these -plan members are also claiming for the services of a psychologist.

So how can new technologies help address this gap? We’re exploring new approaches such as the online delivery of cognitive behavioral therapies (CBT) It’s a great way to deliver therapy, in today’s digital world, where instant access to services in quickly becoming the norm.

The online delivery of CBT can be as effective as face-to-face therapy. It reduces time with clinicians, without losing effectiveness of the treatment. It’s a great solution for many plan members who prefer its convenience, confidentiality.

Bottom Line

Technology for its own sake can be a distraction. By focussing on the results technology can deliver – from making it easier for plan members to submit claims or access mental health support, to providing us with data to ensure our plan designs deliver maximum return on investment – we’re making technology work for everyone’s benefit.

Medavie Blue Cross updates

New Insights Blog Launched

The benefits landscape is changing continually, and keeping on top of it is always a challenge. We’re here to help.

Our new Insights blog is a hub of information including webinar recordings, blog posts, articles and other industry news. It will be updated at least once per month so make sure you stop in often. You can also keep up to date on new posts by following us on LinkedIn and Twitter.

Medavie Health Foundation 2018 Grants Program now open

Medavie Health Foundation is seeking funding applications from community-based organizations focused on improving the lives of those impacted by child and youth mental health, type 2 diabetes and post-traumatic stress disorder.

To apply for funding, organizations must be a registered charity offering programs in one of these three core cause areas. New for this year: no deadline to apply, with applications being accepted year-round. Visit the Foundation’s website for details

Blue Cross recognized as “Most Admired” brand

The Canadian Association of Blue Cross Plans chose to participate in the Léger Corporate Reputation Study again for 2018. The study is designed to reveal the enterprises most admired by Canadians.

We’re pleased to announce that Blue Cross is again recognized as one of Canada’s Top 100 Brands for 2018. This year we’ve moved up almost 10 positions in the top 100 ranking and we’re also pleased to continue to be recognized in the ranking as Canada’s #1 health benefits provider.

More information about the results of this survey can be found online at

2018 Benefits3 Conference Series launches

We launched our 2018 Benefits3 national conference series in Halifax on April 4 and 5. Once again, this highly anticipated conference brought together leading employers, benefits consultants, and respected speakers from across Canada.

This year’s theme Trends that Transform – recognizing the need to revolutionize the way we design and deliver group benefit plans in today’s evolving world. The discussion focussed on innovation and disruption in the health care and group benefits industry, and then moved towards mental health trends on the second day, including how to manage the stresses that accompany change in the workplace. Medavie CEO, Bernard Lord presented to the conference delegates, giving a retrospective on the long history of innovation and leadership at Medavie Blue Cross, as well as how we are uniquely positioned to continue to lead change in Canada’s health care landscape.

Check out #benefits3 on Twitter to see the social engagement from the conference delegates and speakers as well as a time lapse video, showing the creation of a powerful visual summary of the conference discussion.

Medavie Blue Cross will continue this conference series with events in Toronto and Montreal later in the year.

Industry News

Focus on generic drugs paying off

As of April 1, our plans are benefiting from the savings negotiated earlier this year by the pan-Canadian Pharmaceutical Alliance (pCPA), representing all provinces and territories except Quebec, and the Canadian Generic Pharmaceutical Association (CGPA). The prices of nearly 70 of the most commonly prescribed drugs in Canada have been reduced by 25% to 40%. Though private plan sponsors are not represented by the pCPA, these plans still benefit from these reduced generic drug prices.

New generic savings are also in place for plan members in Quebec as of April 3. This is part of a separate agreement between the province and the CGPA that led to a five-year agreement on negotiated pricing agreements.

Leveraging generics to help control drug costs has been an integral part of our drug management strategy for several years, with 80% adoption of Mandatory Generic Substitution among our group plans. That means our clients will see immediate and sustained savings thanks to these agreements.

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