title: Reforming private drug coverage in Canada: inefficient drug benefit design and the barriers to change in unionized settings.
abstract: Prescription drugs are the highest single cost component for employees' benefits packages in Canada. While industry literature considers cost-containment for prescription drug costs to be a priority for insurers and employers, the implementation of cost-containment measures for private drug plans in Canada remains more of a myth than a reality. Through 18 semi-structured phone interviews conducted with experts from private sector companies, unions, insurers and plan advisors, this study explores the reasons behind this incapacity to implement cost-containment measures by examining how private sector employers negotiate drug benefit design in unionized settings. Respondents were asked questions on how employee benefits are negotiated; the relationships between the players who influence drug benefit design; the role of these players' strategies in influencing plan design; the broad system that underpins drug benefit design; and the potential for a universal pharmacare program in Canada. The study shows that there is consensus about the need to educate employees and employers, more collaboration and data-sharing between these two sets of players, and for external intervention from government to help transform established norms in terms of private drug plan design.
authors.affiliation: École de relations industrielles, Université de Montréal, Montreal, Quebec, Canada; Interuniversity Research Centre on Globalization and Work (CRIMT), Montreal, Quebec, Canada.
authors.forename: Sean
authors.initials: S
authors.lastname: O'Brady
authors.affiliation: School of Public Policy and Administration, Carleton University, Ottawa, Ontario, Canada. Electronic address: ma.gagnon@carleton.ca.
authors.forename: Marc-André
authors.initials: MA
authors.lastname: Gagnon
authors.affiliation: Faculty of Human and Social Development, University of Victoria, Victoria, British Columbia, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Cassels
mesh_terms: D002170:Canada; D003362:Cost-Benefit Analysis; D006264:Health Benefit Plans, Employee / Q000191:economics / Q000458:organization & administration; D018166:Health Care Reform / Q000379:methods / Q000458:organization & administration*; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics; D007750:Labor Unions; D009936:Organizational Innovation
keywords: Collective bargaining; Drug coverage; Employee benefits; Health insurance; Pharmaceuticals; Private drug plans