HealthForward was founded in 2012 and offers payers and plan sponsors a unique solution to managing their drug spending for high cost, but critical, specialty medications. HealthForward provides support programs and distribution services on behalf of payers, and in some cases, employers, to eligible plan members (patients).
Specialty drugs are high-cost medications often used to treat complex and chronic conditions. Due to their complex formulation, they often require special storage, handling, administration, and monitoring. They typically require Prior or Special Authorization (PA / SA) from individual insurance companies before plan members can receive a coverage decision during the reimbursement process.
Health Case Management is personalized, one-on-one support for eligible plan members to aid in proactive management of their health condition. HealthForward offers a wide range of Health Case Management services, but can include disease and treatment education, adherence programs, reimbursement administration and coordination of medication delivery. Through Health Case Management, plan sponsors and employers can help improve health outcomes of plan members, while aiding the long-term sustainability of their benefits plan.
The Health Case Manager is a registered nurse who is the plan members’ single point of contact and provides them with ongoing support and monitoring. The Health Case Manager works with the plan member, their physician and insurance provider, and other members of their healthcare team to help identify clinically-effective and cost-effective treatment options for improved patient outcomes.
HealthForward’s was the first to launch a Preferred Pharmacy Network (PPN) in Canada. Our PPN model helps payers and plan member save on specialty medication costs by streamlining distribution and controlling mark-up prices. Eligible plan members can have access to over 2400 designated pharmacies for convenient and flexible dispensing options. Whether the PPN is national or provincial, HealthForward works with plan sponsors to build and manage the right PPN for their plan members.
Pharmacies that are included in our PPN vary by payer program. We have over 2400 pharmacies in our national network that range from large chains to independent pharmacies. Please contact your HealthForward representative for more information.
Due to provincial regulations, we cannot offer our PPN model in Quebec. We offer our Health Case Management services to eligible Quebec residents, and we are actively looking for opportunities to extend our pharmacy services to those individuals.
Our goal at HealthForward is to ensure the plan member is fully engaged in the management of their health condition, from enrollment to ongoing monitoring and support. A recent survey indicated that our plan members have had a very positive experience with HealthForward. A large majority of plan members were extremely satisfied with their Health Case Management team and the wide-range of value-added services offered through our PPN. Please see our Success Stories for more information