The number of high-cost prescription drug claims that Canada's private insurers covered for Canadians with fully-insured supplementary health insurance plans has doubled in the CDIPC’s first year of operation.
“Without this system,” says Frank Swedlove
, President of the Canadian Life and Health Insurance Association
(CLHIA), “many Canadians would be left without access to the prescription drugs they need to help them deal with rare and often life-threatening conditions.”
In 2013, under the new pooling mechanism, insurers in Canada paid more than 4,000 claims for prescription drugs that cost in excess of $25,000. This was up from 2,000 when CDIPC was first established in 2012. Several claims exceeded $500,000, including one claim for more than $1.2 million.
In the absence of a catastrophic drug program in Canada, life and health insurers voluntarily established the CDIPC. Under CDIPC, they share the costs of highly expensive and recurring drug treatments in order to protect fully-insured private drug plans from the full financial impact of high-cost drugs.
By pooling these costs, the industry has taken a proactive approach to sheltering employers, and ultimately employees, from the potential devastating financial impacts that even a single ongoing claim for highly expensive drug treatments could have on the sustainability of supplemental drug plans, and has been particularly beneficial to the small and medium-size business community.
The Canadian Drug Insurance Pooling Corporation (CDIPC) is already proving its value, thanks to the skyrocketing cost of prescription drug claims.