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TORONTO — Shoppers Drug Mart (SDM) has unveiled a website, Shoppers Health Care Portal, designed to facilitate the search for reimbursement information and thereby improve patient care.
Deciphering the rules governing drug reimbursement in jurisdictions across Canada consumes a disproportionate amount of the scarce time of physicians and other health care professionals involved in the prescribing process. Shoppers Health Care Portal, the first of its kind in Canada, is now available to physicians, nurse practitioners and registered nurses.
Registered users will have access through the portal to drug coverage reimbursement and clinical eligibility criteria for more than 200 special authorization medications along with patient assistance program information.
Physicians and other health care professionals can register for the Shoppers Health Care Portal by visiting www.shoppershealthcareportal.org.
“As a patient-focused organization, Shoppers Drug Mart/Pharmaprix is dedicated to making health information and services available to the communities we serve,” says Dr. Dorian Lo, executive vice president of pharmacy and health care. “The Shoppers Health Care Portal will help to provide physicians and extended health care teams with key reimbursement information and requirements needed to ensure their patients receive the most appropriate medications for their condition.”
Lo, whose professional experience includes working in the health care sectors of both the United States and Canada, highlights the differences in practice in securing reimbursement in the two countries.
“In the United States many drug manufacturers provide information on their branded websites about how their more costly specialty prescription medications are covered by each of the payers,” Lo notes. “As well, patients are often required to obtain their prescriptions from pharmacies their PBM [pharmacy benefits manager] works with — and the PBM looks after obtaining the information in order to assess whether the patient is covered.
“In Canada,” Lo continues, “it’s really left to the physician and the pharmacist to navigate on behalf of the patient. There are patient assistance programs for many high-cost drugs, but many drugs don’t have programs at all. The Shoppers Health Care Portal directs the health care professional to the program (if the drug has one) and to the clinical eligibility criteria and prior-authorization forms for the private payers and public programs to help the patient obtain coverage.”
“The drugs for which it is hardest to secure coverage here are usually the ones that require step therapy, such as rheumatoid arthritis and HIV medications as well as oncology drugs,” says Lo. “For step therapy, patients must meet the clinical eligibility criteria and have had to fail other therapies first in order to obtain coverage. This process is rather lengthy, and involves a lot of back and forth between the public or private payer and the physician because the previous therapies may have also required prior authorization.”
Another challenge for the prescriber is that some provinces or private insurers specify that the disease has to have progressed to a certain stage if coverage is to be provided.
Physicians are required to provide all of these details about their patient’s condition for the payer to make the decision about whether to cover the cost of the medication.
The rules governing prior authorizations in public plans vary from province to province and they are different again for patients covered by private payers. For physicians who see many patients a day, completion of the complex prior-authorization paperwork becomes a substantial burden.
“Putting the eligibility criteria, prior-authorization forms and instructions for submitting these payer requests in the hands of the entire health team of prescribers and pharmacists not only makes it easier for the prescriber, but helps patients get their medications quicker,” says Lo.
Every patient’s issues tend to be unique. Lo notes that payers are beginning to realize that it is better to make authorization information more readily available and are providing more online resources. SDM is aggregating that information, says Lo, making it easier for either the prescriber and/or SDM pharmacists to have the necessary conversations with the patient. The Shoppers Health Care Portal makes it easier for prescribers to work with the patient during the appointment and thereafter to submit a request that includes all the relevant information.
The portal, in addition to drug coverage information, will provide registered users with access to the British Medical Journal’s Clinical Assessment Tool, “Best Practice,” which provides information on more than 10,000 conditions, Lexi-CALC medical calculators, the Lexi-Interact drug interaction database, printable patient handouts by condition, links to allied health resources and much more.
