CAPA heard about Manulife’s DrugWatch Program and wanted to fully understand it and provide you with information about it. Below is an article that we have developed on the Program and how it may affect you. We thank our colleagues at Manulife, Lisa Callagan and Matt Miles, for a candid and informative conversation about the Program.

Will Manulife’s DrugWatchTM Program affect you?

If your employer offers you extended health benefits through Manulife, you may be affected by how Manulife will be covering newly released medications in the future. All new drugs in Canada must be given approval by Health Canada before they can be legally sold. If you receive your medications through a provincial public health program, drugs covered by these programs also undergo a review by an arms’ length government body called CADTH (Canadian Agency for Drug and Technologies in Health). CADTH reviews data for these drugs on how well they work in patients and cost is also taken into consideration. CADTH then concludes whether the drug adds value compared to other medicines also available, and recommends whether provinces should approve the drug, approve with conditions (often at a lower price) or not approve the medication. This whole process generally takes at least 7 months, and sometimes longer, and is detailed here in a video on CAPA’s website. Together, provincial public plans also negotiate prices with pharmaceutical manufactures for all new drugs coming to the market. Typically, private insurance plans have provided coverage for medications as soon as Health Canada approves them – they do not undergo the review at CADTH or price negotiation activities.

Manulife’s Drug Watch program is a new paradigm for private insurance companies and a direct result of the cost of new drugs putting pressure on the ability of employers to continue to fund these private plans. This program has been implemented for new medications that have very high risk of creating material new costs for plan sponsors. This means that the drug(s) will also undergo CADTH review and price negotiations before they will be covered. In some extreme cases, if the drugs have no value relative to other medications on the market, they may not be listed for coverage. This now provides a new step in the process for private drug coverage by Manulife, which means that access to new medications for some patients will now take longer, and also means that some new medications may not be made available either. The challenge of increasing costs of medications for employers offering private health insurance coverage is becoming common and Manulife has responded with their DrugWatch program.

CAPA heard about the DrugWatch Program and acted by writing a letter to Manulife that was followed up by a phone call with Matt Miles (Vice President, Product & Marketing, Group Benefits & Retirement Solutions at Manulife Financial) and Lisa Callaghan (Assistant Vice President, Product). We found out some important information to share with you:

1. DrugWatch will be applicable only to new drugs that cost significantly more than current drugs to treat the same illness;
2. DrugWatch will not be applied retrospectively to medications that are currently available on the market;
3. Manulife is committed to following the RA guidelines for treatment that the Canadian Rheumatology Association (CRA) has developed as was announced by the CRA, CAPA and the Canadian Health and Life Insurance Association in September 2015.

So what does this really mean for patients with inflammatory arthritis who are covered by a Manulife program? It means that only if a new inflammatory arthritis medication comes out that is offered at a significantly higher price than current medications, it will go under review. At the moment this is not a likely scenario since we know that most new arthritis medications are similarly priced to those currently on the market. It also means that if you are currently covered by your medication by Manulife, you will not be impacted in terms of this medication. If you have other illnesses, these might be impacted and you should be sure to look in to your coverage.

CAPA expects the Manulife DrugWatch program to evolve over time, and we expect other private insurers to do something similar as the cost of some new medications (e.g. in cancer and in hepatitis where there are now therapies that cure) is near or in the six-figure range. We have encouraged Manulife to consider that our need for treatments changes over time as our arthritis changes – each case is a unique and individual one. We continue to require access to numerous medications. We also encouraged Manulife to consider increased patient input in their processes, and we look forward to working with them in the future on increased patient input in to processes and to ensure communications about their program are clear and factual, so that those in the arthritis community know how they are impacted.

If you have any questions about how the DrugWatch program may affect your access to medications through your Manulife benefits, CAPA has been informed by Manulife that the following medications are undergoing review:

Repatha – a drug for high cholesterol
Opdivo – a skin cancer drug. It is anticipated that this drug will be administered and covered in a hospital setting; however, it is undergoing a review in the event that it ceases to be paid for by hospitals in the future.

We will update this list from time to time.