Site Search

424 results for see web PROBLEMGO.com Buying better housing in prison North Carolina

eDelivery of a Contract - New Business

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):

Equitable Life Group Benefits Bulletin – December 2021 In this issue:

Supporting plan members affected by the flooding in Nova Scotia and Newfoundland*
Update: Changing certificate numbers on EquitableHealth.ca*
Help plan members take advantage of convenient digital options*
Ontario optometrists and government to restart negotiations*
QDIPC updates terms and conditions for 2022*

*Indicates content that will be shared with your clients

Supporting plan members affected by the flooding in Nova Scotia and Newfoundland*

The recent flooding in Nova Scotia and Newfoundland is having a devastating impact on the province’s residents.

Here are some of the ways we can help support your clients’ plan members who are affected by the flooding.

Prescription refills
Until Dec. 31, our pharmacy benefit manager, TELUS Health, will allow early refills for plan members who have been evacuated and/or lost their medication due to the flooding.

Replacement of medical or dental equipment and appliances
If plan members in Nova Scotia or Newfoundland need to replace any eligible medical or dental equipment or appliances (e.g. prescription eyeglasses, dentures, etc.) due to the flooding, they can call us at 1.800.265.4556 before incurring additional expenses to see how we can support them.

Disability or other benfit cheques
If plan members affected by the flooding are receiving disability benefits or other benefit reimbursements by cheque, they can visit www.equitable.ca/go/digital for easy instructions on how to sign up for direct deposit. It’s easy and takes just a few minutes. They can call us at 1.800.265.4556 if they need help. We can also arrange for a different mailing address or replacement cheques if necessary.

Mental Health Support
A natural disaster can also take a serious toll on people’s mental health. All of our plan members have access to the Homeweb online portal and mobile app, including numerous articles, tools and resources designed to provide guidance and support in difficult times. Homewood has put together some suggestions on how to help employees affected by a natural disaster.

For your clients with an Employee and Family Assistance Program, remind them that their plan members have 24/7 access to confidential counselling through a national network of mental health professionals. Whether it’s face-to-face, by phone, email, chat or video, plan members will receive the most appropriate, most timely support for the issue they’re dealing with.

If a client wishes to add the EFAP to their plan, we can do this quickly – often in just a few days. Simply contact your Group Account Executive or myFlex Sales Manager.

Plan Administrator support
We realize that the flooding may also be having an impact on the regular business operations of your clients in Nova Scotia and Newfoundland. If any of your clients are unable to carry out day-to-day plan administration, they can call us at 1.800.265.4556 to see how we can support them.

We know this is a challenging time for many of your clients and their plan members. We will continue to monitor the situation and provide additional updates as appropriate.

Update: Changing certificate numbers on EquitableHealth.ca*

Effective Dec. 10th, plan administrators will no longer be able to update or change plan members’ certificate numbers on EquitableHealth.ca. This change will ensure we can manage these changes more effectively to provide a smoother plan member experience.

If your clients need to update a plan member’s certificate number, please have them reach out to Group Benefits Administration for assistance at groupbenefitsadmin@equitable.ca.

Help plan members take advantage of convenient digital options*

We have several digital options available to make it easier for your clients to do business with us and for their plan members to access and use their benefits plan.

To help build awareness among plan members, we’ve created two posters that your clients can post on their intranet sites or in their office. The posters provide easy instructions on how to activate our secure, digital options.

Please click on the links below to download the posters.

EquitableHealth.ca posters: EZClaim mobile app posters:
EquitableHealth.ca English EZClaim mobile app English poster
EquitableHealth.ca French poster EZClaim mobile app French poster

Ontario optometrists and government to restart negotiations*

The Ontario Association of Optometrists (OAO) announced it has paused its job action and will restart negotiations with the Ontario Ministry of Health on funding for optometry services.

In September, Ontario optometrists began withholding services from patients covered by OHIP, including children, senior citizens and other patients with certain medical conditions, after negotiations with the Ministry of Health over compensation broke down.

Residents of Ontario between the ages of 20 to 64 who aren’t eligible for coverage of eye services under OHIP were not affected by the job action. They were able to continue to receive eye exams from their optometrist and submit eligible claims to their benefits plan.

QDIPC updates terms and conditions for 2022*

Every year, the Quebec Drug Insurance Pooling Corporation (QDIPC) reviews the terms and conditions for the high-cost pooling system in the province. Based on its latest review, QDIPC is revising its pooling levels and fees for 2022 to reflect trends in the volume of claims submitted to the pool, particularly catastrophic claims.

Size of group (# of certificates)	Threshold per certificate 2022	Annual factor (without dependents	Annual factor (with dependents)
Fewer than 25	$8,000	$276.00	$771.00
25 – 49	$16,500	$188.00	$527.00
50 – 124	$32,500	$97.00	$328.00
125 – 249	$55,000	$66.00	$223.00
250 – 499	$80,000	$51.00	$173.00
500 – 999	$105,000	$39.00	$153.00
1,000 – 3,999	$130,000	$34.00	$133.00
4,000 – 5,999	$300,000	$18.00	$71.00
6,000 and over	Free market – Groups not subject to Quebec Industry Pooling

We will apply the new pooling levels and fees to future renewal calculations that involve Quebec plan members.

[pdf] Plan Administrator Guide to EZBenefits
[pdf] Custom Quote - Payout Annuity
[pdf] Change of Sales Charge Option (Pivotal Select)
[pdf] TFSA Third Party Contribution
[pdf] Advisor Attestation - Stylus Signatures
[pdf] Aviation Questionnaire
[pdf] Financial Questionnaire - Business