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

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  • 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
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    References listed on IDEAS

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    1. 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.
    2. 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.
    3. 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.
    4. 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.
    5. 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.
    6. 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.
    7. 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.
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