The legal risks of drug plan design changes

If you are a Mainstay client, then your risk (mentioned in the article) is a bit lower than with most.  You likely have an insured benefit plan (over ASO) and few of our clients reduce or remove drug coverage. That said, sometimes due to rising costs, a drug cap can be appropriate as a last ditch effort to maintain a plan, and risks can arise.  In some cases insurer changes beyond an employers control can cause delays and in some cases, moving to an HSA only plan or dropping a plan altogether can create a risk if someone is on a high cost drug.  All that said, we are lucky in Ontario to have the Trillium Drug Program that can assist in many of these situations..

Drug plan design changes are often unavoidable, whether they’re due to a carrier modifying contracts across the board or an employer looking to manage ballooning costs.