NEXT LEVEL BENEFITS PLAN MANAGEMENT. POWERED BY SMARTSPEND™.
SMARTspend is all about value. It's not enough that a health product or service just delivers something. GSC's strategies (see below) ensure that quality care and health outcomes are always front and centre.
Read more below on some of our SMARTspend highlights.
STRATEGIES THAT SHAPE THE INDUSTRY. THIS IS WHAT WE DO.
When we say GSC has a reputation for developing game-changing cost management solutions and innovative initiatives, this is what we mean.
Since 2016, GSC has stood apart with our approach to biosimilars (aka subsequent entry biologics). Under our formularies, biosimilars are listed as preferred products, and the originator products (biologics) are covered only in exceptional circumstances. This means the most cost-effective, yet equally efficacious treatment is utilized first.
GSC is ideally positioned to help plan sponsors take advantage of the cost savings (savings are estimated between 25% and 47% compared to the originator product), future market forces, and competition that may drive down the prices of biosimilars, while ensuring that plan members receive the most appropriate drug for their condition.
GSC has a couple of key approaches here:
- Initial 10-Day Supply – Prescriptions for high cost drugs (over $40 a day) are limited to a 10-day supply under our long-standing Initial Day Supply feature.
- 30-Day Supply – Once it has been established that the patient can tolerate the drug, we will allow a 30-day supply limit (ongoing use) for this same category of drugs.
The advantages are threefold:
1. Safety – Many of these high cost drugs have special handling instructions due to their toxicity. An unused amount of the drugs could be hazardous to the patient’s household as well as to the environment if they were disposed of improperly.
2. Adherence – When the patient returns to the pharmacist soon after starting the new medication, it provides an opportunity for additional counselling which could facilitate improved patient adherence.
3. Wastage – Many of these drugs are associated with early side effects that cannot be tolerated by some patients; our supply limits will prevent wastage – of both medication and benefit plan dollars.
Through our value-based pharmacy initiative, GSC is the first payor (public or private) in Canada to start measuring pharmacy performance on an individual pharmacy basis. Here's the game plan:
- Since October 2016, we have been supplying all pharmacies across the country with easy-to-understand Patient-Impact Scorecards, based on GSC claims data, which highlight key information regarding patient adherence, safety, and disease management. These monthly scorecards rate the pharmacy’s performance on a set of eight evidence-based measures.
- Later in 2018, Phase 2 will make pharmacy performance information available to plan members through an online search tool. This will enable plan members to choose a pharmacy not only based on factors such as cost and location, but also actual quality of care.
- Phase 3 will tie pharmacy reimbursement to performance scores. This phase is still in the development stage with much consultation and collaboration with the pharmacy community in the coming months.
Why is it that someone can have a major physical injury, illness, or surgery and experience little or no pain, whereas, someone else may have severe pain—that lasts—without being able to identify any physical damage or cause? Herein lies the complexity of chronic pain. It is long-term, non-acute pain that is highly individualized and very difficult to treat. However, a variety of pain management options continue to emerge in the scientific evidence, illustrating that because your plan members’ chronic pain takes on many forms, so too should its treatment.
GSC’s Pain Management Strategy consists of three core initiatives aimed at developing the best, safest plan of care while encouraging plan sustainability:
- Narcotic Pain Management Strategy
- Medical Marijuana Strategy
- Pain Management Mobile App Pilot
We would be pleased to share more information on each of these initiatives.
BEACON is a proven digital mental health therapy program that uses the evidence-based cognitive behavioural therapy (CBT) form of psychotherapy to treat many different mental health conditions. It's also much less expensive than traditional face-to-face therapy sessions. Pair that with a convenient digital delivery via a computer or mobile device, and we have a solution that addresses access, cost, and quality.
As a key component of our mental health strategy, GSC includes the BEACON program as an eligible benefit for plan members and their dependents (age 16 and over) as an option under their existing mental health/counselling coverage. The program is delivered by regulated mental health professionals who develop customized therapy for each patient.
Want to know more? Click here to read an informative primer by Peter Gove, GSC's health management innovation leader and subject matter expert. You can also listen to episode two of our podcast, And Now For Something Completely Indifferent, which discusses the challenges in treating mental illness in Canada and the emergence of digital solutions to help fill the gaps.
Want to promote BEACON in your organization? Here's everything you need:
LEARN MORE ABOUT SMARTSPEND. YOU'LL BE GLAD YOU DID.
Health care costs continue to rise, and that story is not going away. But, through SMARTspend, we've got your back. Let our friendly Account Executives set your mind at ease.