Making sure you use them.
Over 79% of working Canadians enjoy extended health benefits that cover prescription medications, eyeglasses, and services provided by chiropractors, naturopathic doctors, physiotherapists, massage therapists, and much more. Unfortunately, most of these benefits go unused.
Paradoxically, the cost of health benefits continues to rise each year. For many companies, especially small and medium-sized businesses, these increases make it difficult to provide benefits to their employees. Many companies try to reduce these costs by limiting benefits, increasing deductibles, or using creative plan designs.
But how is it that benefit costs continue to escalate even though utilization rates remain relatively low? The short answer is drug spending — used to treat chronic diseases of lifestyle such as heart disease, diabetes, and chronic pain.
So, what can you do?
Well, if you're one of the 25 million Canadians lucky enough to have extended health benefits — use them. Not convinced? Let me explain.
A case study from our research
Let's use type 2 diabetes as an example. Extrapolating clinical findings from our published diabetic research study into potential pharmaceutical cost savings is one model that helps explain this rationale.
Patient 1 in the study was a 65-year-old female on three combined medications for her diabetes — Janumet (metformin + sitagliptin) and gliclazide. After completing a 12-week naturopathic program of care (five visits), she had reduced her Janumet prescription by 75%, completely discontinued the gliclazide, and reduced her blood pressure medication ramipril by 50%.
- HbA1c at start of program: 7.8% (target for most diabetics on medication is 7.0%)
- HbA1c at end of program: 5.4% (normal is less than 5.6%)
- Prescription drug cost savings per year: $1,083.80
- 5-year prescription drug cost savings: $5,419.00
- Total naturopathic costs over 5 years: $950.00
- Total projected net savings over 5 years: $4,469.00
Patient 2 was a 52-year-old male also taking Janumet. After a similar 12-week program, he eliminated his diabetic medication entirely and discontinued his rabeprazole for acid reflux.
- HbA1c at start: 8.0%
- HbA1c at end: 5.5%
- Prescription drug cost savings per year: $1,797.84
- Total projected net savings over 5 years: $8,039.20
Eliminating a patient's need for a single medication like Victoza can save almost $20,000 over five years. Most plans allow only $500 per year for naturopathic care. That's a 10:1 return.
These cost savings are magnified in cases where more expensive medications such as Victoza (liraglutide) are part of the patient's care plan. This excludes any savings from comorbidities — decreasing blood pressure meds, heartburn medication, or the prevention of catastrophic complications like heart disease, kidney disease, blindness, and amputations.
The take-home
It is my strongest assertion that the most direct path to health benefit cost containment is to increase utilization of benefits that promote health and wellness. Many experts agree.
In summary, make preventive medicine your medicine. The best way to both treat and prevent disease is to focus on maximizing your personal wellness. Health benefits are one tool that can help afford you this opportunity.
