Medication generates more than 20 percent of benefit costs in basic insurance. How do we enable our customers to make savings? How do we grant them access to the best possible medical care? The service contractors at Helsana take care of it.
Daniela Zimmermann-Fehr, Head of Service Contracting Pharmaceuticals and Medicinal Products at Helsana
The patient's fingers are painfully inflamed. Rheumatoid arthritis. She takes a medication called Humira. A packet costs more than 800 francs. The price is set by the Federal Office of Public Health. If the medication is on the specialities list, it must be covered by compulsory health insurance. The cost of such a treatment quickly adds up to 20,000 francs or more a year. "Cost savings are nevertheless also possible here," says Daniela Zimmermann-Fehr. She is Head of Helsana's Service Contracting division within the Pharmaceuticals department. "Specifically, if the patient had basic insurance cover with Helsana, she could purchase the medication at a lower price through a partner mail-order pharmacy and would also be entitled to free supplementary insurance benefits, such as consumables or therapeutic support over the phone."
To make such customer advantages possible, Zimmermann-Fehr and her team of five staff negotiate with selected partners on the Swiss healthcare market, from manufacturers to doctors or pharmacists. "We service contractors see ourselves as trustees of our customers. How can we enable them to get cost advantages for medicinal products and medical devices? How can we guarantee access to affordable and better medical care?" states Zimmermann-Fehr. "However, we do not purchase anything as the name service contracting suggests. Instead, we negotiate cheaper sourcing channels with suppliers, make sure discounts are passed on, also by passing on currency advantages, and provide access to innovative products and methods for which there is no authorisation or regulation in Switzerland yet, but abroad there is."
Enabling access to therapies
Patients are frequently reliant on a medicinal product which is not yet recognised in Switzerland as being effective in treating their specific illness and is therefore not generally covered by basic insurance. This can be the case if the studies required for authorisation in Switzerland have not yet been concluded or if it is a very rare illness. Such medicinal products may only be paid for in serious cases if no other authorised medication exists and their efficacy has been established. In such an event, the health insurer can determine the amount covered based on the therapeutic benefits. "Thanks to partnerships with pharmaceutical companies, we can provide our customers with controlled access to these innovative therapies."
Focus on customer benefit
In the example of the patient with the rheumatic remedy, Humira, Helsana cooperates directly with the Rothaus Direct mail-order pharmacy, among others. The latter specialises in supplying medication for rheumatism and disorders of the nervous system, such as multiple sclerosis. "Mail-order pharmacies are very convenient for customers. They don't need to go to the pharmacy especially: the medication is delivered to their home discretely and quickly and settled directly with Helsana. Pharmacists rarely have very expensive products in particular in stock." Mail-order pharmacies meet the growing customer demand for such a service. At Helsana, they reach almost 10 percent of the pharmacy market and generate annual sales of 55 million francs.
Customers of the Helsana Group can also buy most medication from Mediservice, xtrapharm and Zur Rose at a reduced price. This saves almost seven million francs a year. The policyholders and Helsana also save several million francs on glasses and contact lenses thanks to discounts offered by our partner optician's shop, McOptik. "Our customers benefit directly from lower cost prices," says Zimmermann-Fehr, "and indirectly from more stable premiums, because every cost reduction reduces the pressure on the healthcare system." Helsana also has partnerships with doctors' networks, laboratories and suppliers of medical aids. In addition to being medical experts, service contractors also have to be good analysts and able to interpret information correctly. "The pharmaceutical market will not stand still. We are closely following the developments of medicinal therapies and analytical procedures," says Zimmermann-Fehr who is a medical practitioner herself and worked in the pharmaceutical industry for a long time. When both negotiating parties are sitting at the table, she continues, the chemistry must be right and there must be a willingness to jointly develop an offer which is beneficial to policyholders. "I immediately recognise empty marketing clichés and unrealistic business models."
Text: Daniela Schori