helen stevenson is on a mission to make your drugs more affordable
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reformulary group, led by helen stevenson, negotiates lower drug prices with pharmaceutical companies. supplied
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there are about 15,000 prescription drugs on the market, says helen stevenson, founder and ceo of reformulary group in toronto. that number includes ones for common ailments like high blood pressure and cholesterol to those for rare diseases such as certain cancers. how can your doctor or pharmacist know the details of each and every one?
stevenson wants canadians to take an active role in their health by understanding the medications they’re being prescribed and what alternatives might be available to them – drugs that actually may work better and cost less.
her company has an expert panel review new medications and add them to the drug list, the reformulary, which also provides a comparison to similar medications. she talked to healthing.ca about the rising costs of prescription drugs, and how she’s on a mission to make drugs more accessible and affordable for canadians.
what were the issues that made you feel canada needed the reformulary group?
i founded the company 10 years ago. the issues back then are still relevant today. the cost of drugs was increasing quite significantly. i wrote a white paper called ‘an end to blank cheques’ because canadian companies were just writing blank cheques. there was just an open end to drug plans — basically, you can have whatever you want, no matter how much it costs.
the other issue was there was no reliable source of information related to how well the drug works, how much it costs and alternatives for certain drugs. there was this perception that you would leave the pharmacy or your doctor’s office with your prescription and that’s the only drug that will work for you.
you’ve worked extensively in health-care reform, so these issues have likely been on your mind for a long time. how did your past experience help you shape your company?
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i had a consulting business in switzerland and then a consulting business here, and i was approached by the ontario government — by those that knew the work that i had done in health-care systems. i was approached to help reform the big ontario drug benefit program, which is a $5 billion program that was growing at double digits.
we did massive reforms, disrupted, and turned everything upside down. we really tackled all different aspects. for instance, not a single plan at that time negotiated a drug price. we accepted whatever price the pharmaceutical company provided to us. i was brought in to do these very significant reforms and then i was appointed to be assistant deputy minister of health and the ceo of that huge $5 billion program.
it was a privilege because i was exposed to the inner workings of government, and i had a lot of interaction with the private sector, insurance companies, employers, etcetera, and it struck me, they were writing blank cheques. that’s why i decided to leave and build a new kind of formulary — called the reformulary. it’s a drug list that is really clever and helps people make good decisions with respect to drugs — a list that equips and empowers them to make smart choices about their medications. i planned to sell access to our big formulary, or drug list, to companies, unions, associations across the country and negotiate lower prices with pharmaceutical companies, because i had all this experience from government and negotiating prices. and that’s essentially what we did.
tell us more about the issues that reformulary group can help solve.
very few organizations knew what a formulary was and even in the insurance companies, it was just kind of the list in the back of the system. my view was to make it the star of the show. it’s the most important part. it’s like that little computer chip, that microprocessor in your computer — it has all the smarts and yet you don’t see it.
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what many canadians don’t realize is that for the vast majority of drugs, there are alternatives that might work better and cost less, or work the same and cost less. but canadians don’t know that. and we also don’t have access to that information and are not equipped to do that research. so that’s what we took on — along with the medical experts that we work with. we’re coming up on our 120th meeting with our medical experts.
the other point is that drug costs are increasing, so we have a lot of new drugs coming to market. today, we have one that’s $3 million. when i founded the company, we did not have a $3 million drug, although we had a $700,000 drug. we now have multiple $700,000 drugs and a $3 million drug, which typically tends to be for rare diseases.
what has reformulary group done so far to address these issues?
first of all, we negotiate lower drug prices with pharmaceutical companies. we have a mechanism where it essentially goes back through the drug plan, which is a very positive thing. we were one of the first to do that. we had our first agreement over 10 years ago — it’s now become more common among payers and insurance companies.
the other piece is the review that we do of drugs. if our committee says that drug a works really well and the cost is good, fine. let’s say for drug b, the committee says, oh, that drug is okay, but it’s so much more expensive than drug a. we will then provide the list of alternative drugs that work the same and cost less. so we have mapped out the alternatives that either work the same and cost less, or maybe work better. and that’s really our secret sauce that no one has replicated.
this is hugely valuable for our clients, but also for canadians. when we think about all of the uninsured and under-insured, this is really important for those people, too.
now where we are is we’ve proven the value in terms of sustainability, like plans being able to continue to afford providing benefits and, in this post-covid era, if we’re able to generate savings, we have so many success stories of organizations reinvesting those back in other benefits, such as mental health programs. from that perspective, there’s a lot of positivity around it for our clients. we save them money and we’re equipping their plan members with information to make smart drug choices.
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what’s comes next?
we’ve done the reviews and we recommend alternatives. we put [the information] into a tool called drug finder that is available to our clients. but there is a version for the general public that we are working on so that same great advice is available to canadians. we also intend to link them to pharmacies that offer really good price transparency. i’m a real advocate for price transparency around drugs — what i pay, what the markup is, what my dispensing fees are.
we also have huge data sets from prescription claims data. we are launching tools for canadians to be able to track how they feel, for instance: i’m taking this drug and i’m going to track how i feel from a quality of life perspective, from my productivity and my daily responsibilities, be it childcare or a traditional workplace, or caring for a family member. we want to start to link data to make it meaningful to canadians.
why should canadians care?
in our lives, for example, when we buy a car, we research cars, we go talk to dealers. we’re meticulous about our banking. yet most canadians walk out of their doctor’s office with the prescription and might not even look at the name of the drug. they just hand it to the pharmacist.
we should care because physicians typically know about 50 drugs. they can’t possibly be expected to know about 15,000 drugs. their expertise is diagnosing you and your treatment. pharmacists know drugs really well, but not necessarily comparative, like drug a versus b or c versus d.
our purpose is really about making more drugs more affordable for more canadians. we are doing that now vis à vis companies with our product. but we are really moving toward helping canadians. and there are canadians who don’t have coverage, or don’t have enough coverage. this is where we feel we can really play a significant role.
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helen stevenson is ceo of reformulary group.
karen hawthorne is a toronto-based writer.
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