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Responding to Ontario’s biosimilar switch initiative
We are changing coverage for some biologic drugs in Ontario 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 government policy while providing access to equally safe and effective lower-cost biosimilars.
Ontario’s provincial biosimilar initiative
Announced in December 2022, Ontario’s biosimilar switch program ends coverage of eight biologic drugs for Ontario residents covered by the Ontario Drug Benefit (ODB). The transition to biosimilar versions of these drugs began on March 31, 2023. ODB recipients using these drugs will be required to switch to biosimilar versions of these drugs by December 29, 2023, to maintain their provincial coverageEquitable Life’s response
To ensure this provincial change doesn’t result in your clients paying additional and avoidable drug costs, we are changing coverage in Ontario for most biologic drugs included in the provincial initiative.
Beginning October 1, 2023, plan members in Ontario 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.Communicating this change to plan members
We will inform any affected plan members in early August 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.Will this change impact my clients’ rates?
Any cost savings associated with the change will be factored in 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 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 conditionsQuestions?
** The list of affected drugs is dynamic and will change as Ontario includes more biologic drugs in its biosimilar initiative, as new biosimilars come onto the market, and as we make changes in drug eligibility.
If you have any questions about this change, please contact your Group Account Executive or myFlex Sales Manager. - [pdf] Service is our business
- [pdf] myFlex - How it works, what to consider
- [pdf] the myFlex Difference
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Insights from a pandemic: Drug trends during COVID-19
We were expecting drug costs to rise this year due to the increase in “specialty” drugs, the shift to more expensive treatments for common conditions, and the introduction of new, costly medications. The COVID-19 pandemic has caused drug costs to rise even more than expected. While this was partly due to increased claims for certain drug categories, the most significant factor was the increase in dispensing fees as the provinces imposed 30-day refill limits.
Costs and claimants surge, drop, then climb again
Initially, as COVID-19 started to spread, we saw an overall spike in the volume and paid amounts for drug claims in March as plan members rushed to stock up on their medications. On our block, the average amount paid per certificate increased 16% in March, compared with the previous year.
This spike was followed by a drop in April after most provinces put 30-day refill limits in place. This led to a decrease in both average paid amounts and quantity per claim as people were limited to smaller refills. But the dispensing fee portion of drug cost tripled for many plan members who had to refill their prescriptions every month instead of every 90 days.
The April plunge was short-lived. Drug claims started to climb again in May as some provinces removed their 30-day refill limits. We’ve seen a continued increase so far in June as all remaining provinces have lifted their 30-day limits.
Claims for “specialty” drugs increase
There were some notable exceptions to this trend. For example, both claimants and paid amounts for high-cost “specialty” drugs increased in March, April and May. Thirty-day refills are the norm for these drugs, so they weren’t impacted by the re-fill limits.Claims for asthma drugs had the largest surge of any common disease category in March but had no subsequent drop in April. Not surprisingly, claims for mental health drugs increased throughout the pandemic, including a 33% increase in the number of claimants in May.
Going forward, we should see the average quantity per prescription stabilize in future months and return to normal, provided pharmacies return most patients to refills of more than 30 days.
The full impact of COVID-19 remains to be determined. We will continue to provide timely updates on any developments that impact our clients and their plan members or their benefits coverage. In the meantime, please contact your Group Account Executive or myFlex Sales Manager if you have questions.
- New Applications & Transaction Authorization Requirements
- [pdf] Termination for Internal Replacement
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Crunch The Numbers With Equitable Life’s Savings Calculator
Whether helping your client determine net worth or reviewing to see if your client’s retirement plan is on track, Equitable Life® is here to help with our online calculators. These number crunching tools can help you answer some of those challenging questions you get asked by your clients. From an RSP loan calculator to home budgeting to even figuring out if your client will be a future millionaire, check out our latest tools.
Each week in March, we will be sharing an online calculator from our list.
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Amina is going to get in the habit of saving by putting $25 a month into her RRSP. Her friends don’t think it is worth the effort. Does it matter how much you contribute?
Did you know?
Consistent investments over several years can be an effective strategy to accumulate wealth. Check out Equitable Life’s Savings Calculator.
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Crunch the numbers with Equitable Life of Canada
Whether helping your client determine net worth or reviewing to see if your client’s retirement plan is on track, Equitable Life® is here to help with our online calculators. These number crunching tools can help you answer some of those challenging questions you get asked by your clients. From an RSP loan calculator to home budgeting to even figuring out if your client will be a future millionaire, check out our latest tools.
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Gloria and Nigel just launched their small business and have dreams of becoming millionaires. What will it take for them to join the millionaire’s club?
Did you know?
There are many factors to consider including inflation, taxation and rate of return. Check out Equitable Life’s Cool Million Calculator.
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And the winners of Equitable’s New Year’s Resolution, New Year’s Contribution Contest are…
A big thank you for making Equitable’s New Year’s Resolution, New Year’s Contribution contest a huge success.
Clients who made a contribution between January 1 and February 29, 2024, to their Registered Retirement Savings Plan (RRSP), Tax-Free Savings Account (TFSA) or First Home Savings Account (FHSA) could win $5,000 and the advisor could win $1,000.
As a special thank you to our clients and wonderful advisor partners we’ve tripled the fun and appreciation to three prizes.
We’ve now completed the draws and are thrilled to announce the following winners:-
Client: Winnie C., Ontario
Advisor: Rebecca M., Ontario -
Client: Eunice D., Alberta
Advisor: Diamond O., Alberta -
Client: Loyda A., Alberta
Advisor: Michael V., Alberta
Congratulations to our winners!
From all of us at Equitable, thank you for your trust and partnership.
Date posted: April 24, 2024
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