Equitable Life Group Benefits Bulletin – February 2022
- Update: Alberta biosimilar coverage changes*
- Preferred Biosimilar Program*
- Responding to Quebec’s biosimilar policy*
- Dental fee guide updates*
- Reminder: Review manual allocations for HCSAs and/or TSAs*
- Mental health resources for plan members*
Update: Alberta biosimilar coverage changes*
Four originator biologics added to Alberta Biosimilar Initiative
In 2022, Alberta’s provincial drug plan is adding four originator biologics to its Biosimilar Initiative. It has ended or will end provincial coverage of these drugs for some or all conditions, as follows:
- Lovenox: Jan. 10, 2022
- Humalog: Feb. 1, 2022
- NovoRapid: April 1, 2022
- Humira: May 1, 2022
Patients 18 and over who are using these drugs for the affected conditions will be required to switch to biosimilar versions of the drugs to maintain coverage under the province’s government drug plan.
How we are responding to protect our clients
To help prevent this change from resulting in additional costs for our clients’ drug plans while still providing plan members with access to safe and effective medications, we will no longer cover these originator biologic drugs for plan members in Alberta.
Effective May 1, 2022, claimants currently taking these drugs will be required to switch to a biosimilar version of the drug to maintain coverage under their Equitable Life plan.
This is a continuation of the Alberta biosimilar switch program we launched last March, when the province first introduced its Biosimilar Initiative.
Do my clients need to take any action?
No action is required by plan sponsors. Plan members taking these targeted originator biologics will be contacted directly to allow them ample time to transition to a biosimilar. Any cost savings associated with the change will be factored in at renewal.
Groups that opted out of the biologic coverage changes we made last March will automatically be opted out of these coverage changes, as well as any future changes to our Alberta biosimilar switch program. This means that their drug plans will continue to provide coverage to existing claimants for any originator biologics we stop covering as part of our biosimilar program.
Advisors with clients who wish to opt out of our Alberta biosimilar program, or who previously opted out and want to opt back in, should speak to their Group Account Executive or myFlex Sales Manager.
Communication to plan members
We will be communicating these coverage changes with affected claimants in early March to allow them ample time to change their prescriptions and avoid any interruptions in their treatment or their coverage. Thus far, the transition to biosimilars, has been smooth and continues to be successful.
What is the difference between biologics and biosimilars?
Biologics are drugs that are engineered using living organisms like yeast and bacteria. The first version of a biologic developed is known as the “originator” biologic. Biosimilars are also biologics. Biosimilars are highly similar to the drugs they are based on and Health Canada considers them to be equally safe and effective for approved conditions.
Questions?
If you have any questions about this change, please contact your Group Account Executive or myFlex Sales Manager.
Preferred Biosimilar Program*
As part of our ongoing efforts to help ensure the sustainability of your clients’ drug plans, we continue to engage in strategic partnerships with pharmaceutical manufacturers.We are pleased to announce a partnership to make Hyrimoz our preferred biosimilar for Humira. This partnership will generate additional savings for plan sponsors.
Plan members will still have the choice to use Humira biosimilars other than Hyrimoz. However, in the absence of alternative sources of reimbursement, this may increase their out-of-pocket amount.
The Preferred Biosimilar Program will take effect March 1, 2022 for all new claimants across Canada who start using a Humira biosimilar. It will take effect May 1 for existing claimants in Alberta who switch to a Humira biosimilar, to align with changes to the provincial plan.
Questions?
If you have any questions about this change, please contact your Group Account Executive or myFlex Sales Manager.
Responding to Quebec’s biosimilar policy
Last year, the Quebec government announced it is phasing out coverage of biologic drugs. Beginning April 13, 2022, patients in Quebec using originator biologics will be required to switch to the corresponding biosimilar covered on the province’s public plan in order to maintain coverage.The following populations are excepted from this new policy:
- Pregnant women, who should be transitioned to biosimilars in the 12 months after childbirth.
- Pediatric patients, who should be transitioned to biosimilars in the 12 months after their 18th birthdays.
- Patients who have experienced two or more therapeutic failures while being treated with a biologic drug for the same chronic disease.
We are actively investigating the impact of this new policy on private drug plans in Quebec. We plan to implement further enhancements to our biosimilar programs in Quebec later this year to help prevent this change from resulting in additional costs for our clients’ drug plans. We will provide more details in the coming months.
Dental fee guide updates
Each year, Provincial and Territorial Dental Associations publish fee guides. Equitable Life uses these guides to help determine the reimbursement limits for dental procedures. For your reference, below is the list of the average dental fee increases for general practitioners that will be used by Equitable Life for 2022.*Dental fee guide increases over 2021*
| Province/Territory | Average Fee Increase |
| Alberta | 3.9% |
| British Columbia | 7.35% |
| Manitoba | 5.79% |
| New Brunswick | 5.9% |
| Newfoundland and Labrador | 5% |
| Nova Scotia | 7.05% |
| Northwest Territories | 3% |
| Nunavut | 3.1% |
| Ontario | 4.75% |
| Prince Edward Island | 4.75% |
| Quebec | 5% |
| Saskatchewan | 5.99% |
Reminder: Review manual allocations for HCSAs and/or TSAs*
If your client’s Health Care Spending Account (HCSA) and/or Taxable Spending Account (TSA) has manual allocations, they need to allocate these amounts to plan members each year. Please review all your plan members’ profiles on EquitableHealth.ca to ensure they have received their allocation(s) for the current benefit year.If your clients have Plan Administrator update access on EquitableHealth.ca, they can update these amounts online by doing the following:
- Select “View certificate”
- Select “Health Care Spending Account” or “Taxable Spending Account”
- Select “Update Allocation” in Task Center
- Enter amount in “Revised Allocation Amount”
- Override Reason – “Plan Administrator Request”
- Select “Save”
- Select “Reports”
- Select “New”
- Select “Next”
- Select “HCSA” or “TSA Totals by Plan Member”
- Select “Next”
- Enter end date of “12/31/2020”
- Select “Next”
- Select “Finish”
- View “Report”
Mental health resources for plan members*
As the COVID-19 pandemic continues to evolve, many Canadians are experiencing increased levels of stress, anxiety, and depression. Through our partnership with Homewood Health®, all of our clients and their plan members have access to a number of health and wellness resources designed to provide guidance and support. These resources include a number of webinars which discuss various COVID-19 and mental health-related topics. The webinars are pre-recorded so plan members can stream them at their convenience.Understanding the Impact of COVID-19 on Your Mental Health
English webinar
French webinar
COVID-19: Loneliness & Isolation Fatigue - Self-Care Strategies
English webinar
French webinar
COVID-19: Dealing with Seasonal Affective Disorder
English webinar
French webinar
Reducing Anxiety & Managing the Transition Back to the Classroom - for Teachers
English webinar
French webinar
COVID-19: Specialized Mental Health Support for Health Care Professionals
English webinar
French webinar
COVID-19: Supporting Children’s Mental Health
English webinar
French webinar
Additional resources, including articles, tools, videos and podcasts, are available at Homeweb.ca/Equitable. Please encourage your clients to share these resources with their plan members.