IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v122y2018i12p1295-1301.html
   My bibliography  Save this article

Surviving niche busters: Main strategies employed by Canadian private insurers facing the arrival of high cost specialty drugs

Author

Listed:
  • Charbonneau, Mathieu
  • Gagnon, Marc-André

Abstract

The Canadian patchwork system of prescription drug coverage and the employer sponsored private health benefits group plans appear vulnerable to cost growth due to insufficient balance of power between fragmented public and private buyers, and pharmaceutical manufacturers. The emergence of “bad” insurance risks caused by new and very expensive treatments featuring high cost specialty medicines – also known as niche buster drugs – exposes this vulnerability. This study fills a gap in knowledge by seeking to better understanding how Canadian private insurers face the arrival of specialty pharmaceuticals. It completes an overview of a body of grey literature composed of publicly available online articles from the employment benefits and group insurance consulting and administration industry; online documents from group benefits sector conferences; and online or on demand materials from Canadian life and health insurers. Claims for high cost specialty drugs generate new bad insurance risks that Canadian health insurers attempt to mitigate through isolated corporate initiatives, industry-wide strategies and calls for universal, public catastrophic coverage. The outcomes of these strategies are limited cost-control measures as well as risk and cost transfers onto plan sponsors, patients and provincial public programs.

Suggested Citation

  • Charbonneau, Mathieu & Gagnon, Marc-André, 2018. "Surviving niche busters: Main strategies employed by Canadian private insurers facing the arrival of high cost specialty drugs," Health Policy, Elsevier, vol. 122(12), pages 1295-1301.
    • Handle: RePEc:eee:hepoli:v:122:y:2018:i:12:p:1295-1301
    DOI: 10.1016/j.healthpol.2018.08.006
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0168851018303877
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.healthpol.2018.08.006?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Owen Adams & Jordyn Smith, 2017. "National Pharmacare in Canada: 2019 or Bust?," SPP Research Papers, The School of Public Policy, University of Calgary, vol. 10(5), March.
    2. Jeremiah Hurley & Emmanuel Guindon, 2008. "Private Health Insurance in Canada," Centre for Health Economics and Policy Analysis Working Paper Series 2008-04, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
    3. Mélanie Bourassa Forcier & Pierre-Carl Michaud & Aurélie Côté-Sergent & Stéphanie Boulenger & Camille Lachance Gaboury & Claire Abbamonte, 2017. "Fonctionnement du marché des assurances privées de personnes dans le cadre de l’assurance médicaments et son encadrement réglementaire au Québec," CIRANO Project Reports 2017rp-04, CIRANO.
    4. Law, Michael R. & Daw, Jamie R. & Cheng, Lucy & Morgan, Steven G., 2013. "Growth in private payments for health care by Canadian households," Health Policy, Elsevier, vol. 110(2), pages 141-146.
    5. O’Brady, Sean & Gagnon, Marc-André & Cassels, Alan, 2015. "Reforming private drug coverage in Canada: Inefficient drug benefit design and the barriers to change in unionized settings," Health Policy, Elsevier, vol. 119(2), pages 224-231.
    6. Tom Baker, "undated". "Containing the Promise of Insurance: Adverse Selection and Risk Classification," University of Connecticut School of Law Working Papers uconn_ucwps-1002, University of Connecticut School of Law.
    7. Mélanie Bourassa Forcier & Pierre-Carl Michaud & Stéphanie Boulenger & Aurélie Côté-Sergent & Claire Abbamonte & Camille Lachance Gaboury, 2017. "Fonctionnement du marché des assurances privées de personnes dans le cadre de l’assurance médicaments et son encadrement réglementaire au Québec (ANNEXES)," CIRANO Project Reports 2017rp-04a, CIRANO.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Rick A Vreman & Thomas F Broekhoff & Hubert GM Leufkens & Aukje K Mantel-Teeuwisse & Wim G Goettsch, 2020. "Application of Managed Entry Agreements for Innovative Therapies in Different Settings and Combinations: A Feasibility Analysis," IJERPH, MDPI, vol. 17(22), pages 1-20, November.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Laetitia Lebihan, 2023. "The impact of a mandatory universal drug insurance program on health behaviors and outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 32(9), pages 2006-2046, September.
    2. Grignon, M. & Longo, C.J. & Marchildon, G.P. & Officer, S., 2020. "The 2018 decision to establish an Advisory Council on adding pharmaceuticals to universal health coverage in Canada," Health Policy, Elsevier, vol. 124(1), pages 7-11.
    3. Baird, Katherine Elizabeth, 2016. "The incidence of high medical expenses by health status in seven developed countries," Health Policy, Elsevier, vol. 120(1), pages 26-34.
    4. Katherine Baird, 2016. "Recent Trends in the Probability of High Out-of- Pocket Medical Expenses in the US," LIS Working papers 675, LIS Cross-National Data Center in Luxembourg.
    5. J.C. Herbert Emery, 2016. "Tax-Assisted Approaches For Helping Canadians Meet Out-of-Pocket Health-Care Costs," SPP Research Papers, The School of Public Policy, University of Calgary, vol. 9(23), June.
    6. Karen Yeung, 2018. "Algorithmic regulation: A critical interrogation," Regulation & Governance, John Wiley & Sons, vol. 12(4), pages 505-523, December.
    7. Katherine Baird, 2018. "Including Private Health Care Costs in Measuring Nations’ Redistributive Effort," Journal of Income Distribution, Ad libros publications inc., vol. 26(2), pages 1-21, July.
    8. Katherine Baird, 2016. "The Financial Burden of Out-of-Pocket Expenses in the US and Canada: How Different is the US?," LIS Working papers 671, LIS Cross-National Data Center in Luxembourg.
    9. Pulok, Mohammad Habibullah & Hajizadeh, Mohammad, 2022. "Equity in the use of physician services in Canada's universal health system: A longitudinal analysis of older adults," Social Science & Medicine, Elsevier, vol. 307(C).
    10. Kartashova, Katya & Tomlin, Ben, 2017. "House prices, consumption and the role of non-Mortgage debt," Journal of Banking & Finance, Elsevier, vol. 83(C), pages 121-134.
    11. Hajizadeh, Mohammad & Pandey, Sujita & Pulok, Mohammad Habibullah, 2023. "Decomposition of socioeconomic inequalities in catastrophic out-of-pocket expenditure for healthcare in Canada," Health Policy, Elsevier, vol. 127(C), pages 51-59.
    12. G. Kent Fellows & Daniel J. Dutton & Aidan Hollis, 2018. "Making Sure Orphan Drugs Don’t Get Left Behind," SPP Communique, The School of Public Policy, University of Calgary, vol. 10(6), August.
    13. Wang, Chao & Li, Qing & Sweetman, Arthur & Hurley, Jeremiah, 2015. "Mandatory universal drug plan, access to health care and health: Evidence from Canada," Journal of Health Economics, Elsevier, vol. 44(C), pages 80-96.
    14. Katherine Baird, 2016. "The Incidence of High Medical Expenses by Health Status in Seven Developed Countries," LIS Working papers 670, LIS Cross-National Data Center in Luxembourg.
    15. Thomas P. Weil, 2016. "What can the Canadians and Americans learn from each other's health care systems?," International Journal of Health Planning and Management, Wiley Blackwell, vol. 31(3), pages 349-370, July.
    16. Katherine Baird, 2018. "Accounting for Private Health Care Expenses in Measures of Nations’ Redistributive Effort," LIS Working papers 749, LIS Cross-National Data Center in Luxembourg.
    17. Sara Allin & Jeremiah Hurley, 2009. "Inequity in publicly funded physician care: what is the role of private prescription drug insurance?," Health Economics, John Wiley & Sons, Ltd., vol. 18(10), pages 1218-1232, October.
    18. Sterling Edmonds & Mohammad Hajizadeh, 2019. "Assessing progressivity and catastrophic effect of out-of-pocket payments for healthcare in Canada: 2010–2015," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(7), pages 1001-1011, September.
    19. Lawrence J. White, 2020. "Antitrust Economics And Consumer Protection Economics In Policy And Litigation: Why The Disparity?," Economic Inquiry, Western Economic Association International, vol. 58(4), pages 1555-1564, October.
    20. Chao Wang, 2012. "Mandatory Universal Drug Plan, Access to Health Care and Health: Evidence from Quebec, Canada," Department of Economics Working Papers 2012-14, McMaster University.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:122:y:2018:i:12:p:1295-1301. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.