Insurer Case Management and Patient Support Program Services in Canada

Benefits Canada

Insurer case management (ICM) programs and patient support programs (PSPs) both have a goal to provide services that will help maximize health outcomes for Canadian patients who are prescribed high-cost specialty medications. Manufacturer-funded PSPs provide reimbursement navigation, education, and medication administration and logistical support to patients who are prescribed a specialty therapy. Insurer-funded programs aim to help patients adhere to their treatment plans, and to collect important information to assist insurers in making coverage decisions. There are benefits and differences between these two models, which are important for insurers and plan sponsors to understand.