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1. October 2019 Advisor eNews

   Coverage of Remicade, Enbrel and Lantus in BC

   As we announced in August, BC PharmaCare recently introduced a new Biosimilars Initiative that ends coverage of three biologic drugs, including Remicade, Enbrel, and Lantus. These drugs will no longer be eligible in British Columbia for most conditions for which lower-cost biosimilar versions are available. Patients in the province with these conditions will be required to switch to biosimilar versions of these drugs by Nov. 25, 2019 in order to maintain their coverage under BC PharmaCare. Patients taking Remicade for Crohn's Disease or Ulcerative Colitis will not be required to switch to a biosimilar until March 6, 2020.
    
   Biologics are drugs that are engineered using living organisms, such as yeast and bacteria. Biosimilars are highly similar to the originator drugs they are based on and most have been shown to have no clinically meaningful differences in safety or efficacy.
    
   To ensure this provincial change doesn’t result in your clients’ plans paying additional drug costs, we have aligned our drug eligibility for these three biologic drugs with that of BC PharmaCare.
    
   As previously announced, effective Nov. 25, 2019, Remicade and Enbrel will no longer be eligible for BC plan members with conditions for which lower-cost biosimilar versions of the drugs are available. These plan members will be required to switch to the biosimilar versions of these drugs in order to maintain eligibility on the Equitable Life drug plan. We have communicated with Plan Administrators about this change, and we have informed affected claimants of the need to switch medications.  
    
   As well, effective Feb. 3, 2020, the drug ingredient cost for Lantus will no longer be eligible for BC plan members; only the dispensing fee may be eligible under their Equitable Life plan. Plan members taking Lantus will be required to switch to Basaglar, the lower-cost biosimilar version of the drug, in order to maintain coverage under their Equitable Life plan. We will be communicating with Lantus claimants in the coming weeks to allow them 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.

   De-listed service providers

   As part of our ongoing initiative to have Group Benefits plans only reimburse eligible claims, we conduct reviews of the billing and administrative practices of service providers, including clinics, facilities and medical suppliers.

   As a result of these reviews we may de-list certain providers.  We will no longer accept, or process claims for services and/or supplies obtained from those providers. The plan member can still choose to obtain services or supplies from these providers, but Equitable Life will not provide reimbursement for the claims.

   Review Equitable Life’s de-listed service providers

   The delisted service provider list is also posted on EquitableHealth.ca for plan members to review to determine if their claim(s) are eligible for reimbursement under their Group Benefits plan.

   For more information about protecting group benefits plans from abuse, check out our articles.

2. Additions and Increases
3. [pdf] Guide to drug plan management
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5. Path to Success Module 6
6. About
7. Online Annuity Quotation
8. Online Annuity Quote
9. Changes to the PMPRB

   Earlier this month, the Government of Canada announced the final amendments to the Patented Medicines Regulations. These changes will impact how the Patented Medicine Review Board (PMPRB) sets the ceiling price for patented drugs and evaluates if the price of a drug reflects the value it has for patients. The intent of these updates is to enable the PMPRB to more effectively protect Canadians from excessive patented drug prices.

   These changes do not come into effect until July 1, 2020. Finalizing the guidelines and consultation with stakeholders will occur leading up to this date. It is yet to be determined which drugs will be included in the final guidelines. It is anticipated the guidelines will initially focus on drugs launched shortly prior to and after July 1, 2020.

   Equitable Life supports the modernization of the PMPRB and the ongoing need to evolve drug plan management tools in order to support the health of Canadians and drug plan affordability for public and private payers.

   If you have any questions, please contact your Group Account Executive.

10. Policy endorsement: Long Term Disability pre-existing condition period

    We are updating our contracts to clarify how we handle the Long Term Disability (LTD) pre-existing condition period for employees returning from maternity or paternity leave.

    A new LTD pre-existing condition period will no longer apply when an employee re-enrols in the benefits plan after their maternity or paternity leave ends, provided that they return to work on the date agreed upon with their employer, or in the time period allowed by the Employment Insurance Act, whichever is earlier.

    To facilitate this change, we are amending some of the wording in our contracts and booklets, effective March 1, 2020. Below are links to the Endorsement to the Master Policy and the Summary of Master Booklet Wording Changes for this amendment. Please download and save these policy endorsement documents for your files.

    In addition, please remind your clients to provide all of their plan members with a copy of the Summary of Master Booklet Wording Changes.

    The next time your clients amend their benefits plan, the updated wording will be included in their group benefits plan booklets.
    
    Download Endorsement to the Master Policy
    Download Summary of Master Booklet Wording Changes