SEBs: Private Payer Perspective Carlyn Volume-Smith, B.Sc.Pharm., M.Sc., Ph.D. Senior Manager, Benefit Services.

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Presentation transcript:

SEBs: Private Payer Perspective Carlyn Volume-Smith, B.Sc.Pharm., M.Sc., Ph.D. Senior Manager, Benefit Services

Private Payer Focus Member experience Retention of workforce Plan sustainability Positive impacts on other lines of benefit Highly Competitive Environment

Traditionally…… Price levers Drug plan features – Special authorization – Restricted benefits – Management limitations Generic pricing

SEBs: a new beast…. Looked at our traditional sources… – Health Canada – CADTH – Provincial drug plans – Clinical guidelines and experience % savings from SEBs not as substantial as first thought, but the absolute amount of potential savings is impressive

Today Understand complexity Patient, biologic, costs Want to get it right A sustainable solution that does not negatively impact member Open to opportunities