When severe illness strikes, expert support makes treatments manageable


We all know that even a bad cold makes life significantly harder: The smallest problems loom large and we feel awful. Poor sleep can leave us feeling more troubled and anxious than usual.

When severe illness strikes, this whole-life impact is magnified. It’s no surprise, then, that Canadians who are diagnosed with multiple sclerosis (MS), people like Heather, need help managing their complex medical treatments.

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For reasons that have yet to be discovered, Canada has one of the highest rates of MS in the world, with one in every 385 people diagnosed with the disease. People with MS face an uncertain future, as its progression is unpredictable. It attacks the nervous system, causing symptoms and complications that include fatigue, weakness, vision and bladder problems, and cognitive impairment. It affects the mind, body and emotions. It also affects financial wellbeing, as some of the medications used to moderate symptoms and disability are enormously costly.

Heather was prescribed a specialty drug that’s been shown to reduce the frequency aof MS attacks. It also costs about $33,000 a year. She has several of the many complications associated with MS, and so has been prescribed a number of additional drug therapies. Like many people with chronic diseases, she has also been diagnosed with clinical depression and takes antidepressants.

Express Scripts Canada research reveals the usual trajectory for Canadians with chronic disease: without expert support at the right time, they get worse, too fast. They’re unable to manage their complex care regimens and often do not take their medications as directed; they spend much more than they have to because they can’t identify the most effective (and cost-effective) drug options.

Fortunately, Heather is a member of what is called a “comprehensively managed plan.” That means that her employer sponsors a benefit plan that does more than process and pay a percentage of approved claims—it provides the expert support she needs to optimize her healthcare and avoid unnecessary spending.

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When one of Heather’s doctors prescribed a new medication after her employer introduced the plan, a Therapeutic Resource Centre (TRC) specialist pharmacist reached out to her by phone to arrange a personalized clinical assessment. The pharmacist identified a number of potential drug interactions that could have resulted in bad health outcomes, and with Heather’s permission, contacted her doctors to resolve the problems. Her drug plan also helped her apply for a patient support program offered by the specialty medication’s manufacturer, that saved Heather some money. “Channel management,” which provides access to a network of preferred pharmacies with reduced markups and dispensing fees, led to additional annual savings in excess of $1,000 for Heather’s plan and $250 in her pocket. She also gets all her medication refills delivered to her home when she’s due to run out, meaning she never has to miss doses because she is too busy or sick to get to the pharmacy.

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Dealing with severe illness will never be easy. But Heather’s comprehensively managed plan has made it as easy as possible to benefit fully from her treatments. Just as importantly, it’s reduced her worries. She is saving money. She knows she’s making the right drug choices at all times and that prescription drug experts are proactively keeping an eye on any potential interactions or side effects. When Heather has questions or issues, she knows whom to call—and that her TRC team will always be there to help.

The support she receives means Heather can stay healthier, be more productive at work and maintain her quality of life longer. For her and for her employer, that’s the best possible outcome.

This case study is taken from Express Scripts Canada’s Prescription Drug Trend Report for 2017. Learn more about comprehensively managed plans and prescription drug spending trends by reading the report.