Balancing Costs With Care

The lack of understanding around healthcare is nowhere more evident than in the area of employer-sponsored drug plans. In addition, insurers sometimes would not pay for coverage of certain drugs unless patients can demonstrate that they really need them -- a process called "Special Authorizatio...

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Bibliographic Details
Published in:Benefits Canada 2007-11, Vol.31 (11), p.71
Main Author: O'Reilly, Hugh
Format: Article
Language:English
Subjects:
Arthritis
Authorizations
Cost control
Disease
Employee benefits
Employers
Health insurance
Human rights
Medical treatment
Patients
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Summary:The lack of understanding around healthcare is nowhere more evident than in the area of employer-sponsored drug plans. In addition, insurers sometimes would not pay for coverage of certain drugs unless patients can demonstrate that they really need them -- a process called "Special Authorization." Special Authorization is often justified on the basis that patients get the best care when they receive the most appropriate drug, which is not necessarily the most expensive drug. But it is easy to see another motivation for having a Special Authorization process in place: to save money. Given the potential for human rights concerns, employers are advised to review their benefits plans and ask if there is a Special Authorization process in place for any products, as well as the scientific basis for any such process.
ISSN:0703-7732