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Equitable Life Group Benefits Bulletin - April 2021
In this issue:
- Alberta biosimilar coverage changes*
- New Humira biosimilars approved*
- Saskatchewan and Manitoba delist biologics for some conditions*
Update: Alberta biosimilar coverage changes take effect*
In our November 2020 edition of eNews, we announced we are changing coverage for some biologic drugs in Alberta in response to the province’s Biosimilar Initiative.
As of March 15, 2021, several originator biologic drugs are no longer covered for plan members in Alberta. Plan members taking these biologics are required to switch to the biosimilar versions of these drugs to maintain eligibility under their Equitable Life plan.
Affected drugs and conditions – Remicade remains eligible
We initially announced that Remicade would be among the biologic drugs no longer covered in Alberta.
We have since determined a method to maintain ongoing eligibility of Remicade while reducing or eliminating any Coordination of Benefit risk associated with the provincial change. As such, Remicade will continue to be eligible for coverage.
Communication to plan members and plan sponsors
We communicated directly 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. The transition to biosimilars, when required, has been smooth and continues to be successful.
Plan sponsors were notified even earlier to allow ample time to opt-out of this change. The vast majority have accepted the changes and are benefiting from a smooth plan member transition.
Looking ahead
We are one of the few insurers taking a comprehensive and proactive response to the Alberta Biosimilars Initiative. We will continue to monitor developments related to the coverage of biologics in Alberta and other provinces and will continue to take steps to protect your clients’ drug plans.
Questions?
If you have any questions about this change, please contact your Group Account Executive or myFlex Sales Manager.
New Humira biosimilars approved*
Beginning in February, Health Canada approved seven new biosimilars for Humira, a biologic drug for the treatment of rheumatoid arthritis, psoriatic arthritis, Crohn's disease and many other conditions. Most of these biosimilars have already been launched and are available in pharmacies.
Humira is one of the highest ranked drugs in terms of total annual cost. All the Humira biosimilars are priced 40% lower than Humira and represent a savings opportunity for private drug plans.
BC Pharmacare has already announced that, effective October 7, 2021, all claimants for most conditions will only be eligible for Humira biosimilars.
We have implemented national controls to ensure the use of Humira biosimilars for new claimants. As with all biosimilar programs at Equitable Life, they will continuously evolve such that our clients are provided appropriate risk protection.
Saskatchewan and Manitoba change coverage for some biologics*
The Saskatchewan government recently announced that, effective March 1, 2021, new patients will no longer be eligible for coverage of Enbrel under its public plan. New patients will only be eligible for biosimilar versions of Enbrel.
Similarly, the Manitoba government announced changes to its tiered biologics program. Currently, claimants are expected to try biosimilars listed under Tier 1 of the program before they can be considered for coverage under the public plan for either Enbrel or Remicade, which are Tier 2 drugs. Effective April 1, 2021, Brenzys, an Enbrel biosimilar, has been added to Tier 1 for some additional medical conditions. As well, Avsola has been added as another Tier 1 biosimilar for Remicade. These changes further expand the Manitoba government’s utilization of biosimilars as preferred therapies over originator 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.
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.
*Indicates content that will be shared with your clients
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Equitable Life Group Benefits Bulletin - October 2022
Introducing new Gender Affirmation Coverage for group benefits plans
Providing an inclusive benefits plan can play a critical role in fostering a workplace culture that welcomes diversity and helps employees thrive. While most provinces cover the cost of gender-affirming surgery, each person has unique needs. Some may require procedures that are not publicly covered.
That’s why we’re pleased to introduce a new coverage option for gender affirmation surgical procedures that are not covered by provincial health plans. Gender Affirmation Coverage helps plan sponsors to close the gap where provincial health coverage ends.Coverage details and eligibility
Gender Affirmation Coverage can be added to any Equitable Life plan with an in-force Extended Health Care plan. It provides coverage for gender-affirming procedures that are not covered by provincial health plans. This might include tracheal (Adam’s apple) shaving and voice surgery. It will also cover some additional procedures to further align the plan member’s features to the transitioned gender, such as facial bone reduction and cheek augmentation. This makes a wider variety of gender-affirming surgeries accessible to plan members and helps minimize their out-of-pocket costs.
Plan members are eligible for coverage with a diagnosis of gender dysphoria from a qualified health care professional.Offering a more inclusive benefits plan
The coverage provides one more way for your clients to offer more inclusive coverage and to offer holistic support to their plan members undergoing a gender transition. We have developed this coverage as a complement to our existing coverage options, including Health Care Spending Accounts (HCSAs), Taxable Spending Accounts (TSAs), Extended Health Care and drug coverage, and Employee and Family Assistance Programs, all of which can provide support to plan members undergoing gender affirmation.
We regularly review our products to ensure that they’re meeting your clients’ needs, and we’re committed to offering products that support diversity, equity and inclusion.
We also continue to review our forms, documents and processes to make them more inclusive. This includes reviewing our online plan member enrolment (OPME) tool to allow for more flexibility with the way plan members identify their gender.Gender affirmation and mental well-being
Gender affirmation procedures can lead to improved mental health outcomes for those with gender dysphoria, as most report an improvement in their quality of life following the procedures. Gender dysphoria may occur when a person’s assigned sex at birth does not match their identity, and people experiencing gender dysphoria typically report psychological and emotional distress, including symptoms of depression or anxiety. By offering coverage where provincial health coverage ends, your clients can support plan members as they seek procedures that align their body presentation with their self-identified gender.
Advantages at a glance
Advantages for plan members include:- Reimbursement for some procedures and expenses, leading to fewer out-of-pocket costs
- May experience improved mental health outcomes after surgery
- A benefits plan that promotes a culture of diversity, equity and inclusion, which may build employee loyalty
- Support for plan member mental health to help those with gender dysphoria thrive
The Benefits Canada 2022 Health Care Survey results are in!
Equitable Life is proud to be a Platinum sponsor for The Benefits Canada 2022 Health Care Survey, Canada’s leading survey on workplace benefits plans. This year’s survey report highlights many fascinating insights across a wide variety of benefits topics, including:- A focus on mental health for both plan sponsors and plan members
- The repercussions of the "shadow" pandemic due to health care delays
- Trends in plan members' overall perceptions of their health benefits plans
- The types of benefits getting more attention from plan members
- The role of remote work in plan member satisfaction
We’re committed to helping you and your clients navigate the evolving landscape of employee benefits in Canada by contributing to this vibrant industry community. To read the full report, visit Benefits Canada.
HCSA and TSA manual allocation reminder
If your clients’ Health Care Spending Account (HCSA) and/or Taxable Spending Account (TSA) have manual allocations, they need to allocate these amounts to plan members each year. Clients should review their plan members’ profiles on EquitableHealth.ca to ensure they have received their allocation(s) for the current benefit year. Your clients may also order HCSA and TSA forfeiture reports on EquitableHealth.ca.
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 12/31/2022
- Select Next
- Select Finish
- View Report
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Take the emotions out of investing
Investing without letting our emotions take the wheel can be quite a challenge. We've all made decisions based on our feelings rather than logic or financial sense at some point. But following our emotions when investing is a good way to put our investment plan at risk.
When it comes to financial planning, it's crucial to guide clients towards being rational investors who understand that market fluctuations are part of the journey. Even the most steadfast rational investors have found it tough to stay calm amidst recent market volatility. But history reassures us that this too shall pass, and the markets will rise again. The burning question is always, "When?"
While no one can predict the future, an advisors’ role is to help clients grasp that risk management is a cornerstone of any solid investment strategy. Risk is just one of the building blocks in crafting a financial portfolio that can weather both good times and bad.
That’s why Equitable® has created an emotional investing brochure to help clients manage through extraordinary times. Download your copy of Take emotions out of investing. We have also included a template letter that you can personalize and use to reach out to clients. To download an editable copy, click here.
Questions? Contact your Director, Investment Sales.
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