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Policy endorsement: Contracts and group benefits plan booklet updates related to BC PharmaCare Biosi
As we announced in the June 2019 issue of eNews, BC PharmaCare recently introduced a new Biosimilars Initiative that ends coverage of three biologic drugs, including Remicade, Enbrel, and Lantus. These drugs will no longer be eligible in British Columbia for most conditions for which lower-cost biosimilar versions are available. Patients in the province with these conditions will be required to switch to biosimilar versions of these drugs by Nov. 25, 2019 in order to maintain their coverage under BC PharmaCare.
The following table outlines the affected originator drugs and their biosimilars.
Drug Originator Biosimilar etanercept Enbrel® Brenzys®
Erelzi™infliximab Remicade® Inflectra®
Renflexis®insulin glargine Lantus® Basaglar™
Biologics are drugs that are engineered using living organisms, such as yeast and bacteria. Biosimilars are highly similar to the originator drugs they are based on and most have been shown to have no clinically meaningful differences in safety or efficacy.
To ensure this provincial change doesn’t result in your clients' plans paying additional drug costs, we are aligning our drug eligibility for these three biologic drugs with that of BC PharmaCare.
To facilitate this change, we are amending some of the wording in our contracts and booklets, effective Oct. 1, 2019. Below are links to the Endorsement to the Master Policy and the Summary of Master Booklet Wording Changes for those amendments. Please download and save these policy endorsement documents for your files.
In addition, please remind your clients to provide their plan members with a copy of the Summary of Master Booklet Wording Changes. The next time your clients amend their benefits plans, the updated wording will be included in their group benefits plan bookletsDOWNLOAD ENDORSEMENT TO THE MASTER POLICY
DOWNLOAD SUMMARY OF MASTER BOOKLET WORDING CHANGES
As of Nov. 25, 2019, Remicade and Enbrel will no longer be eligible for BC plan members with conditions for which lower-cost biosimilar versions of the drugs are available. These plan members will be required to switch to the biosimilar versions of these drugs in order to maintain eligibility on the Equitable Life drug plan.
We will be communicating with affected claimants in the coming weeks to allow them ample time to change their prescription and avoid any interruptions in their treatment or their coverage.
We intend to take a similar approach to Lantus. However, we are still investigating the options to implement this change. We will be communicating with you in the coming weeks to confirm our approach for this drug.
If you have any questions about this change, please contact your Group Marketing Manager or myFlex Sales Manager.
® and ™ denote trademarks of their respective owners -
Changes to the PMPRB
Earlier this month, the Government of Canada announced the final amendments to the Patented Medicines Regulations. These changes will impact how the Patented Medicine Review Board (PMPRB) sets the ceiling price for patented drugs and evaluates if the price of a drug reflects the value it has for patients. The intent of these updates is to enable the PMPRB to more effectively protect Canadians from excessive patented drug prices.
These changes do not come into effect until July 1, 2020. Finalizing the guidelines and consultation with stakeholders will occur leading up to this date. It is yet to be determined which drugs will be included in the final guidelines. It is anticipated the guidelines will initially focus on drugs launched shortly prior to and after July 1, 2020.
Equitable Life supports the modernization of the PMPRB and the ongoing need to evolve drug plan management tools in order to support the health of Canadians and drug plan affordability for public and private payers.
If you have any questions, please contact your Group Account Executive.
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August 2019 Advisor eNews
Coming soon:
Tech updates for plan members
Technology doesn’t stand still, and neither does your clients' businesses. That’s why we continually invest in technology to make things easier for your clients and their employees.
Faster claims processing on Equitable EZClaim® Mobile
Equitable Life now provides real-time processing of massage therapy, physiotherapy and chiropractor claims submitted via the EZClaim Mobile app.
That means plan members are able to find out the status of their claim almost instantaneously. And, for approved claims, they will receive payment even sooner - often in as little as 24 hours.
In order to allow for instantaneous processing and faster payment, plan members will be prompted to enter some additional information including the practitioner’s name, the date of the expense, and the type and amount of the expense, when submitting their claims for these services.
Equitable Life plan members can submit all types of health and dental claims via EZClaim Mobile, including co-ordination of benefits and Health Care Spending Account claims. Currently, 43% of all claims are submitted through the user-friendly app.
AS part of our ongoing efforts to improve the mobile claims experience for plan members, we've also added biometric login functionality to allow plan members to sign in to the app using their face or fingerprint. And we've redesigned our landing page on the mobile app to make it easier for plan members to navigate the various features of the app.
We will be announcing this enhancement to plan members on EquitableHealth.ca
Introducing InpatProtect:
Health coverage for employees who are new to Canada
For a new employee starting to work in Canada, looking after basic health needs can be difficult.
There’s a waiting period for provincial health coverage, and group benefits plans don’t cover the physician, hospital or emergency services that they or their eligible dependents may need during their initial months in the country. They could end up incurring significant unexpected health expenses.
That’s why Equitable Life has launched InpatProtectTM. InpatProtect provides temporary coverage to look after the basic health needs of employees and their eligible dependents during their transition to Canada. Your clients can recruit from outside the country knowing that their employees will have some protection in the event of a medical need, including an emergency.
For up to 90 days, InpatProtect will cover employees and their eligible dependents for basic services that would normally be reimbursed under provincial health plans, such as:
- Physician services
- Prescriptions for medications
- Diagnosis and treatment for illness or injury
- Hospital services
- In-patient services
- Drugs prescribed and delivered as an inpatient in-hospital
- Out-patient services
- Emergency services
- Ambulance services
- Emergency dental services
Contact your Group Marketing Manager or myFlex Sales Manager for more information about this new product from Equitable Life.
De-listed service providers
As part of our ongoing initiative to have Group Benefits plans only reimburse eligible claims, we conduct reviews of the billing and administrative practices of service providers, including clinics, facilities and medical suppliers.
As a result of these reviews we may de-list certain providers. We will no longer accept, or process claims for services and/or supplies obtained from those providers. The plan member can still choose to obtain services or supplies from these providers, but Equitable Life will not provide reimbursement for the claims.
Review Equitable Life’s de-listed service providers
The delisted service provider list is also posted on EquitableHealth.ca for plan members to review to determine if their claim(s) are eligible for reimbursement under their Group Benefits plan.
For more information about protecting group benefits plans from abuse, check out our articles.
1 Based on Equitable Life health and dental claims submitted between January 2019 – March 2019
Google Home and Google Assistant are registered trademarks of Google LLC.
® denotes a trademark of The Equitable Life Insurance Company of Canada unless otherwise indicated. - Physician services
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Update: Improved Employee Assistance from Homewood Health
As we announced in June, we are expanding our relationship with Homewood Health to help you meet the mental health and wellness needs of your employees and their families. Beginning Oct. 1, 2019, Homewood will be the new provider of both our Employee and Family Assistance Program (EFAP) and our online health and wellness services.
Following the transition to Homewood, plan members will benefit from added features:
- Signing in to Homewood Health online allows the platform to customize content unique to your interests.
- All plan members will have access to a Health Risk Assessment to help identify health and wellness barriers.
- i-Volve, Homewood's online cognitive behavioural therapy program is available for all plan members to help them manage anxiety and depression.
Learn more about Homewood Health and how they will be providing your plan members with exceptional EFAP and online health and wellness resources.
What does the transition to Homewood mean for you and your plan members?
We will be working with you in the coming months to facilitate the transition and support your employees. Most importantly, there will be no disruption of service delivery to employees who are currently in short-term counselling with our current EFAP provider.
The transition timeline
Groups without an EFAP
Online health and wellness resources will be available through EquitableHealth.ca just as they are now. Here's what you can expect in the coming months.
September
- We will send plan administrators an email with more details about the resources available to assist in the transition, including:
- How to register for Homewood Health online
- A video orientation for plan members
October
- October 1st – plan members can access the Homewood online resources! They simply need to visit homeweb.ca/Equitable to sign up and create their unique login.
The transition timeline
Groups with an EFAP
We’ve created a helpful infographic that outlines the steps involved in the transition to the Homewood Health EFAP over the coming months. Please save or print it for easy reference. Below are some of the highlights.
August
- We will send plan administrators an email with official notice that the enrolment certificate for our current EAP provider, LifeWorks, will terminate on Sept. 30, 2019, and that Homewood Health Inc. will be our new Employee Assistance Program provider as of Oct. 1.
September
- Homewood will send you a welcome email, including how to access the EFAP, who to contact for support and where to find resources to help share the news with plan members.
- Homewood will follow up directly to answer any questions you may have.
- Homewood will begin offering orientation and training sessions for both plan administrators and plan members. These will be running throughout the fall so you can attend at your convenience.
October
- October 1st – plan members can access the Homewood EFAP and online resources! They simply need to visit homeweb.ca/Equitable to sign up and create their unique login.
- Orientation and training sessions will continue to be available for both plan administrators and plan members throughout October.
Learn More
The resources listed below answer common questions about Homewood and our EFAP transition:
If you have a question that is not addressed here, please contact your Group Account Executive or myFlex Sales Manager.