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  1. February 2023 eNews

    Responding to Nova Scotia’s biosimilar switch initiative

    We are changing coverage for some biologic drugs in Nova Scotia in response to the province’s biosimilar initiative. These changes will help protect your clients’ plans from additional drug costs that may result from this new government policy while providing access to equally safe and effective lower-cost biosimilars. 

    Nova Scotia’s provincial biosimilar initiative

    Announced in February 2022, the Nova Scotia Biosimilar Initiative ends coverage of seven biologic drugs for residents enrolled in Pharmacare programs.

    Pharmacare patients in the province using these drugs will be required to switch to biosimilar versions of these drugs by February 3, 2023, in order to maintain their Nova Scotia Pharmacare coverage. 

    Equitable Life’s response

    To ensure this provincial change doesn’t result in your clients’ plans paying additional and avoidable drug costs, we are changing coverage in Nova Scotia for most biologic drugs included in the provincial initiative.

    Beginning June 1, 2023, plan members in the province will no longer be eligible for most originator biologic drugs if they have a condition for which Health Canada has approved a lower cost biosimilar version of the drug.** These plan members will be required to switch to a biosimilar version of the drug to maintain coverage under their Equitable Life plan.  

    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 Nova Scotia plan members can submit a policy amendment. Amendments must be submitted no later than April 1, 2023. Advisors with myFlex Benefits clients who wish to maintain coverage of these originator biologics for Nova Scotia plan members should speak to their myFlex Sales Manager to confirm their eligibility to opt out of this change.

    Groups that choose to maintain coverage of these originator biologics for existing claimants will also maintain coverage for any originator biologics that we subsequently add to our Nova Scotia biosimilar initiative.  

    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.

    Communicating this change to plan members

    We will inform any affected plan members in April of the need to switch their medications so that they have ample time to change their prescriptions and avoid any interruptions in treatment or coverage. 

    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 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.

    **The list of affected drugs is dynamic and will change as Nova Scotia includes more biologic drugs in its biosimilar initiative, as new biosimilars come onto the market, and as we make changes in drug eligibility.
     

    Changes to New Brunswick drug interchangeability rules

    We are introducing changes to help ensure that your clients with voluntary or mandatory generic pricing for their drug plans will benefit more from the cost savings of these two features, regardless of the province where the drugs are dispensed.

    Currently, when determining whether a lower-cost alternative is available for a brand-name drug, most insurers only consider drugs that the provincial drug plan identifies as interchangeable.

    However, the public drug plan in New Brunswick does not identify a drug as interchangeable if the drug is not listed on its formulary – even if Health Canada has deemed the drug interchangeable.

    As a result, plans with mandatory or voluntary generic pricing have continued to reimburse some drugs in New Brunswick based on the cost of the brand-name drug, even if a lower-cost generic alternative is available.

    Effective March 20, 2023, if your clients have drug plans with mandatory or voluntary generic pricing, we will adjudicate any drug claims in New Brunswick using the lowest cost alternative that Health Canada approves as bioequivalent. This will occur even if the public drug plan has not identified the drug as interchangeable.

    To benefit from this more robust drug plan control, plan sponsors must have mandatory or voluntary generic pricing in place.

    For more information about this change or about implementing mandatory or voluntary generic pricing for your clients, please contact your Group Account Executive or myFlex Sales Manager.
     

    New template: plan members eligible for additional coverage

    Often, based on salary, some plan members may become eligible to apply for extra Life, Accidental Death & Dismemberment (AD&D), Short Term Disability or Long Term Disability coverage. If this occurs, your clients receive a notification from Group Benefits Administration. We have now developed a template that your clients can provide to applicable plan members if they become eligible for extra coverage. The template makes it simpler for your clients to pass on these details to their plan members efficiently.

    The new template is available for download under the Quick Links section of EquitableHealth.ca. It is a fillable PDF form that your clients can complete and provide to their plan members when necessary. The document is called Over the Non-Evidence Limit for Plan Members Notification.

    If you have any questions about the template, please contact your Group Account Executive or myFlex Sales Manager.
  2. Equitable Life Group Benefits Bulletin – March 2022 In this issue: *Indicates content that will be shared with your clients
     

    CLHIA launches industry anti-fraud initiative*

    In February, the Canadian Life and Health Insurance Association (CLHIA) announced a new anti-fraud initiative that is using advanced artificial intelligence (AI) to further identify and reduce benefits fraud.
     
    Equitable Life is excited to be a part of this important initiative. It will enhance our own fraud detection analytics by using AI to connect the dots across a huge pool of anonymized claims data. This will lead to more investigations and actions to mitigate the impact of fraud on your clients’ plans.
     
    The initiative is being led by the CLHIA and member insurers and is supported by technology provider Shift Technologies. It will be further rolled-out and expanded over the next three years.
     
    Benefits fraud affects more than just insurers. The costs of fraud are felt by employers and their employees as well. We are looking forward to being able to better identify and reduce benefits fraud.
     

    Provincial biosimilar update*

    BC expands its biosimilar initiative
    BC Pharmacare recently announced it is adding two rapid-acting insulins to the list of drugs included in its ongoing initiative to switch patients to biosimilar versions of high-cost biologics. Patients taking Humalog or NovoRapid for Type 1 or Type 2 diabetes will be required to switch to a biosimilar version of the drugs by May 29, 2022 to maintain coverage under the public plan.

    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 biologic drugs they are based on, and Health Canada considers them to be equally safe and effective for approved conditions.

    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 Humalog or NovoRapid for plan members in BC. Effective June 1, 2022, claimants currently taking Humalog or NovoRapid will be required to switch to a biosimilar version of the drugs to maintain coverage under their Equitable Life plan and their BC Pharmacare plan.

    We will be communicating this change to plan administrators later this week. And we will be communicating with affected claimants in early April to allow ample time to change their prescription and avoid any interruptions in their treatment or their coverage.
    If you have any questions about this change, please contact your Group Account Executive or myFlex Sales Manager.

    Nova Scotia and Northwest Territories introduce biosimilar initiatives
    The governments of Nova Scotia and the Northwest Territories each recently announced they are launching biosimilar initiatives to switch patients from certain originator biologic drugs to biosimilar versions of the drugs.

    Patients in Nova Scotia using affected originator biologic drugs will have until February 2023 to switch to a biosimilar version of their medications in order to maintain coverage under the province’s public drug plans. Patients in the Northwest Territories will have until June 20, 2022, to switch.

    Equitable Life® actively monitors and investigates all biosimilar policy changes and the ongoing evolution of biosimilar drugs entering Canada.  We will keep you informed of any impact on private drug plans and how we are responding.
     

    Quebec decreasing insurance premium tax*

    The Quebec Government has announced that it plans to decrease its Insurance Premium Tax rates effective April 1, 2022. The premium tax rates for group life and accident and sickness insurance are expected to decrease from 3.48% to 3.3%. The new tax rates will be applied to premiums for the billing period beginning on or after April 1, 2022.
     

    Coming soon: A survey to understand how we can better serve your clients’ needs*

    We are committed to providing your clients and their plan members with industry-leading service. We’ve introduced several enhancements over the past year to make it easier to do business with us. And we’re continually looking for ways to improve.
     
    In the coming weeks, we will conduct a survey of your clients to help us understand how we can better serve them. On March 28, we will send plan administrators an email with a link to the survey. The survey will remain open until the end of the day on April 11 and will take between five and 10 minutes to complete. Please encourage your clients to participate. Their feedback will be confidential, and their responses will help us improve our service and ensure we’re meeting their expectations. We may also follow up with plan administrators directly to address any concerns they’ve identified.
     
    We know your clients’ time is valuable. So, each plan administrator who completes the survey will be entered into a random draw for a chance to win one of 25 prepaid gift cards for $25.
     

    Remind your clients’ plan members in BC, Manitoba and Saskatchewan to register for Pharmacare*

    If your clients have plan members in British Columbia, Manitoba or Saskatchewan, the provincial government offers a Pharmacare program to support prescription drug costs.  Plan members in these provinces must register for their provincial Pharmacare program to maintain coverage under their Equitable Life drug plan.
     
    Registration is easy! We will send two registration reminder messages directly to plan members’ pharmacists and post them on their Explanation of Benefits. We’ve also created a step-by-step guide that your clients can share with their plan members.
     
    English version
    French version
     
    For more information about the provincial Pharmacare programs, including how plan members can register, please visit:
     
    For British Columbia residents: https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/pharmacare-for-bc-residents  
     
    For Manitoba residents: https://www.gov.mb.ca/health/pharmacare/apply.html
     
    For Saskatchewan residents: https://www.saskatchewan.ca/residents/health/prescription-drug-plans-and-health-coverage/extended-benefits-and%20drug-plan/drug-cost-assistance#eligibility
     
     
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