December 11, 2015

Pangaea Express: DrugWatch™

by Beverley Herczegh, Director

Manulife has introduced its new DrugWatch™ program for all clients with a Manulife drug plan.

What is Drug Watch™?
All high cost and/or high volume new drugs will be subject to a financial assessment and those considered to pose significant financial risk (to Manulife clients and their employees) will undergo Drug Watch™ evaluation.

This evaluation is to:

  • Assess the value (comparative drug effectiveness relative to cost)
  • Pursue best prices from manufacturers and where appropriate, require adherence programs or exclusive distribution arrangement as a condition of coverage

The CADTH review decision will be considered in the first step of the DrugWatch™ evaluation process. As such, the time to inclusion on the Manulife drug plan will be governed by the wait time for the critical CDR decision and the time for completion of the Drug Watch™ Evaluation. More delay to coverage.

Manulife’s DrugWatch™ “Oversight Committee” of pharmacists, benefits and financial professionals reviews the data to determine whether the drug will be:

  • Listed
  • Listed with price adjustment
  • Listed with program introduced
  • Listed with price adjustment and program introduced
  • Not listed

This is an unprecedented tactic in the private drug coverage landscape and may have some broad implications. Where Manulife does not cover a medication and the claim is picked up by a spousal plan under co-ordination of benefits (COB) we will see shifting share at the insurer level which may bring other insurers to implement similar tactic(s). This program may also shift market share at pharmacy, at distribution and potentially at the molecule level.

Is this the beginning of PCPA pricing in the private sector? Either way, if you are in are near a launch, you may need to take a second look at those forecasts.

For further information, please contact Bev Herczegh, Director, The Pangaea Group or by phone at 647-407-3592