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Equitable Life Group Benefits Bulletin – February 2022 In this issue:

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*

*Indicates content that will be shared with your clients

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 18^th birthdays.
Patients who have experienced two or more therapeutic failures while being treated with a biologic drug for the same chronic disease.

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.

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%

*Data for all provinces and territories was not available at the time of publication. This chart will be updated on EquitableHealth.ca as more information becomes available.

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”

If your clients have Plan Administrator reporting access on EquitableHealth.ca, they can determine which plan members have a zero allocation by running the “HCSA Totals by Plan Member” report online by doing the following:

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”

To provide us with the amounts to be updated, please have your client contact our Group Benefits Administration Team at GroupBenefitsAdmin@equitable.ca.

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.

About
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* Applies to FundSERV trades occurring between May 20 and August 31, 2022. Initial commission on non-FundSERV trades occurring between May 20 to August 31, 2022 increases from 4% to 5%. Initial commission is subject to a chargeback.
** Equitable Life reserves the right to end the campaign at any time and without notice.

™or ® denotes a registered trademark of The Equitable Life Insurance Company of Canada.
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¹Sequence-of-returns risk, or sequence risk, is the risk that an investor will experience negative portfolio returns very late in their working life and/or early in retirement.
® denotes a registered trademark of The Equitable Life Insurance Company of Canada.
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COVID-19 Group Benefits Updates

Responding to Alberta's Biosimilar Initiative

Beginning March 15, 2021, we are changing coverage for some biologic drugs in Alberta in response to the province’s Biosimilar Initiative. These changes will help protect your clients from additional drug costs that may result from this new government policy while still providing access to equally safe and effective biosimilars.

What is Alberta’s Biosimilar Initiative?

Alberta’s Biosimilar Initiative will end provincial coverage of several originator biologic drugs for some or all conditions beginning on Jan. 15, 2021. 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.

What is the impact on private drug plans?

Industry response to Alberta’s Biosimilar Initiative has the potential to significantly impact your clients’ drug plan costs. If other insurance carriers follow suit with the province and delist the originator biologics, it could expose a plan that doesn’t delist them to significant coordination of benefits risk. (See Case Study below.)

How is Equitable Life responding?

To protect your clients’ plans from paying additional and avoidable drug costs, we are changing coverage in Alberta for most biologic drugs included in the provincial initiative.

As of March 15, 2021, several originator biologic drugs will no longer be covered for plan members of all ages in Alberta. Plan members taking these biologics will be required to switch to the biosimilar versions of these drugs to maintain eligibility under their Equitable Life plan.

What drugs and conditions are affected?

The following table outlines the drugs and conditions that will be affected by this change. The list of affected drugs or conditions is dynamic and will change as Alberta includes more biologic drugs in its Biosimilar Initiative, as new biosimilars come onto the market, and as we make changes in drug eligibility.

Drug name	Originator biologic These drugs will no longer be covered in Alberta for the conditions listed in this table.	Biosimilar Plan members will need to switch to these medications to maintain coverage under their Equitable Life plan.	Affected health conditions The changes in coverage apply to these conditions.
Etanercept	Enbrel	Brenzys Erelzi	Ankylosing Spondylitis Rheumatoid Arthritis Polyarticular juvenile idiopathic arthritis (JIA) Psoriatic Arthritis Plaque Psoriasis (adults and children)
Infliximab	Remicade	Inflectra Renflexis Avsola	Ankylosing Spondylitis Plaque Psoriasis Psoriatic Arthritis Rheumatoid Arthritis Crohn's Disease (adults and children) Ulcerative Colitis (adults and children)
Insulin glargine	Lantus	Basaglar	Diabetes (Type 1 and 2)
Filgrastim	Neupogen	Grastofil Nivestym	Neutropenia
Pegfilgrastim	Neulasta	Lapelga Fulphila Ziextenzo	Neutropenia
Glatiramer*	Copaxone	Glatect TEVA-Glatiramer Acetate	Multiple Sclerosis

*Glatiramer is a non-biologic complex drug.

How will Equitable Life communicate this change to plan members?

We will be communicating with affected claimants in January 2021 to allow them ample time to change their prescriptions and avoid any interruptions in their treatment or their coverage.

Can my client maintain coverage of these biologic drugs?

Traditional groups who wish to opt out of this change and maintain coverage of these originator biologics for Alberta plan members can submit a policy amendment. Amendments must be submitted no later than January 15, 2021. Advisors with myFlex Benefits clients who wish to maintain coverage of these originator biologics for Alberta plan members should speak to their myFlex Sales Manager to confirm their eligibility to opt out of this change.

Will this change impact my clients’ rates?

The rate impact of this change in coverage will be relatively insignificant. Any cost savings associated with the change will be factored in at renewal.

If plan sponsors opt out of these changes and maintain coverage for the originator biologics, it may result in a rate increase. Any rate adjustment will be applied at renewal.

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 also known as the “originator” biologic. Biosimilars are also biologics. They are highly similar to the originator drug they are based on and have been shown to have no clinically meaningful differences in safety or efficacy.

Questions?

If you have any questions about this change, please contact your Group Account Executive or myFlex Sales Manager.

CASE STUDY: The Alberta Biosimilar Initiative and Coordination of Benefits (CoB) risk

CoB risk is real and can be significant, even if a pharmaceutical savings program exists.

The industry response to Alberta’s Biosimilar Initiative has the potential to significantly impact your clients’ drug plan costs. Some insurers may follow the province’s lead and delist these originator biologics. Others may cut back coverage to the cost of the biosimilars or maintain coverage of the originators. These differences could expose a plan that doesn’t delist the originator biologics to significant coordination of benefits risk. Here’s how:

Let’s assume there are two private drug plans – Plan A and Plan B. Both plans are open plans with no deductible. Plan A has 80% co-insurance and Plan B has 100% co-insurance.

BEFORE Alberta’s Biosimilar Initiative

Before Alberta’s Biosimilar Initiative, both plans cover the originator biologics listed above.

Plan A is the first private payer for an Alberta plan member taking an originator biologic drug for Rheumatoid Arthritis. Plan B is the second private payer. The cost of the originator biologic for the plan member is $30,000 annually. Here’s how the coordination of benefits would look before Alberta’s Biosimilar Initiative.

AFTER Alberta’s Biosimilar Initiative

In response to Alberta’s Biosimilar Initiative, the insurer for Plan A delists the originator biologic and requires plan members to switch to the biosimilar. The insurer for Plan B maintains coverage of the originator biologic. Under this scenario, if the plan member doesn’t switch, Plan B essentially becomes the first payer and sees their annual cost increase by 400% (from $6,000 to $30,000).

Even if the insurer for Plan B cuts back coverage to the cost of the biosimilar or adjusts the paid amount because they have a savings program in place with the drug manufacturer, the impact could be significant. For example, if the insurer cuts back coverage to 50% (or $15,000 annually), Plan B would see a 150% annual cost increase (from $6,000 to $15,000):