Medavie Blue Cross, the pharmacy benefit manager and insurer, has introduced a drug management solution that promises to promote cost-effectiveness and positive health outcomes within group plans.
The new solution, named Rxperience, comes with increased standardized core benefits that include broader drug coverage, open access to traditional drug benefits, and specialty drug management.
“Our commitment as a health solutions partner is to improve the wellbeing of Canadians,” said Shane Reid, director, Drug, Product and Provider Management, Medavie Blue Cross. “We leverage our in-house expertise and capabilities to assess, negotiate and recommend to our clients the best approaches to maximizing the outcomes of their drug spend, while ensuring plan members get access to the most appropriate therapy for their condition.”
The key plan management features focus on member care and cost management tools such as priori authorization for high-cost specialty drugs, mandatory generic substitution for multi-source brand drugs, and an opioid management strategy for responsible drug utilization.
Among the add-on automated plan management features available – some of which depend on whether a client is within or outside Quebec – are tiered coinsurance, automated step therapy, and access to a preferred network of pharmacy partners.
The plan also comes with the flexibility to enhance coverage with additional benefit modules. Coupled with plan management features, it allows for more tailored and client-focused health solutions that are adaptive to new or existing plans.
“With Rxperience, our focus is offering a plan that allows for increased access to medications and variety, providing our plan sponsors with sustainable, flexible options, and most importantly, reducing administrative barriers to health care,” Reid said.
Rxperience, Medavie Blue Cross added, is also fuelled by what it described as “unique in-house capabilities” that include:
- Clinical and therapeutic expertise to inform and promote correct drug decisions;
- Technology platforms that offer a seamless member experience;
- Health and disability expertise to enable synchronized benefit offerings for holistic member care;
- Strategic partnership networks with pharmacies, manufacturers, and suppliers to drive quality and increased overall access; and
- Analytics and insights that allow access to data-driven trends and plan innovation.