Background

In the next decade, annual private-sector employee health and dental benefit costs in Canada will approach $25 billion. Approximately 40% of this is related to drug costs with the balance attributable to dental and a wide array of extended health care claims. These costs have risen dramatically over the past number of years and are predicted to continue to rise at an alarming rate. Drug cost escalation alone is trending at 16 to 20% per annum and, at that rate, costs would double in less than 5 years. A new paradigm for providing benefits is needed.

The current health benefits market faces increasing challenges:

  • The existing insurance-centric model adds an expensive administrative layer to costs.
  • Most benefit management systems are 12 to 15 years old and require major redesign to enable flexibility in plan design.
  • The pharmacist's role as a healthcare professional able to help contain costs is neither recognized nor utilized.
  • Improved health outcomes are not being realized.
  • Chronic diseases that were fatal 10 years ago consume over 60% of today’s health care costs and will only increase with time.
  • Cost escalation continues unchecked with no real protection against catastrophic claims experience
NexgenRx™  addresses these limitations by:
  • Dealing directly with plan sponsors or their intermediaries.
  • Lowering costs by charging for claim processing on a transaction basis rather than the value of the claim.
  • Accommodating sophisticated plan designs with flexible, leading edge, rules-based technology.
  • Providing the NexgenRx Intervention Suite™ for drug claims and outcomes management.
  • Facilitating ancillary insurance protection against excessive losses.
  • Encouraging active pharmacist participation in prescription therapy plans.
  • Providing retrospective claims analysis by health professionals as well as prospective trending to give plan sponsors an idea of future claim patterns and costs.