Letter to the Canadian Pharmacists Association regarding an updated pharmacy claims standardRelease Date: 07/14/2015 Staff Reference: Stephen Frank
July 14, 2015
Mr. Perry Eisenschmid
Chief Executive Officer
Canadian Pharmacists Association
1785 Alta Vista Drive,
Ottawa, ON K1G 3Y6
Dear Mr. Eisenschmid
At our last CPhA Pharmacy Claims Standard Working Group #2 - Governance and Business Model meeting this spring, we committed to document our thoughts regarding our preferred governance approach for the updated claims standard. Our strong preference continues to be that any updated claims standard should be a jointly - owned, jointly governed and jointly funded standard. All three key stakeholders, private payers, governments and pharmacy should have equal rights and obligations in this regard.
Private insurers and pharmacists have worked with each other, their service providers and other participants in the benefit claims processing industry for a number of years to facilitate and promote the electronic submission of pharmacy benefit claims. This successful business relationship has provided significant advantages to patients, to pharmacists and insurers. We believe it is important that all parties collaborate to move forward on a national basis in ways that protect and enhance this process and sustain and grow its many advantages. Below, we have taken the liberty of highlighting a number of key principles that, from our perspective, support the need for a joint approach to any new pharmacy claims standard.
1. Independent Businesses
We believe it is important that all parties recognize that the businesses of Payors (government and private) and Pharmacists are independent and that neither Pharmacists nor Payors should be able to dictate how the other side of the claims exchange will conduct its internal business. As well, neither side should be able to dictate the timing or direction of future reforms to the pharmacy benefit claims standard.
2. An Open and Innovative Market
We believe that the exchange of electronic pharmacy benefit claims should be conducted in an open market that encourages innovation. In this regard, it is important that no party have sole control and ownership of any claims standard.
3. Governance and Funding
To foster a trusting relationship, we believe it is important that all parties have an equal obligation from a funding perspective, as well as an equal weight in any governance structure. We also believe it is important that all stakeholders agree to develop a governance framework designed to approach issues in a constructive and collaborative manner and to ensure ongoing interaction and cooperation.
We believe consideration should be given to creating a governance committee composed of senior representatives of government, private payers and pharmacists. This committee would be accountable to set the relevant strategic direction for the system and to serve as a dispute resolution committee to facilitate the resolution of issues which have implications on the various parties involved.
We look forward to a productive discussion with the Working Group at our next meeting on this important matter. I would be pleased to discuss any of the industry's views or to provide further information, in advance of this if you would find it helpful.
Original signed by
Vice President, Policy Development and Health