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

Mathieu Charbonneau and Marc-André Gagnon

Health Policy, 2018, vol. 122, issue 12, 1295-1301

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.

Keywords: Prescription drugs; Technology; High-cost [N03.880.502]; Insurance; Pharmaceutical services [N03.219.521.576.343.575]; Health benefit plans; Employee [N03.219.521.576.343.290]; Health care reform [N03.349.285] (search for similar items in EconPapers)
Date: 2018
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

Downloads: (external link)
http://www.sciencedirect.com/science/article/pii/S0168851018303877
Full text for ScienceDirect subscribers only

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:eee:hepoli:v:122:y:2018:i:12:p:1295-1301

DOI: 10.1016/j.healthpol.2018.08.006

Access Statistics for this article

Health Policy is currently edited by Katrien Kesteloot, Mia Defever and Irina Cleemput

More articles in Health Policy from Elsevier
Bibliographic data for series maintained by Catherine Liu () and ().