Editorial: Projections for drug costs a mixed bag for plan sponsors

Our clients have seen average OVERALL benefit plan rate increases (including all benefits, not just drugs) of less than 4.5% over the past 15 years.  2017 brought some higher increases averaging 7.5% (partly due to aging) but according to the article below, we may see the rate of increase slow again over the coming year.

According to projections released by Aon Hewitt in December, costs for extended health-care plans will likely rise by six per cent in 2018. After inflation of 2.1 per cent, the net projected cost increase is 3.9 per cent. That’s down measurably from an overall cost increase of eight per cent in 2017 and a net rise of 6.1 per cent. And the numbers compare well to the global gross cost increase of 8.4 per cent.  For Article CLICK HERE

Seminar to help staff navigate prescription drug claim issue

My association (Canadian Group Insurance Brokers – CGIB.CA) is holding a seminar for brokers, insurers and employers on Wednesday February 28th from 8 am until noon in Vaughan.  Tickets are $175 but FREE to Mainstay clients.  We have a limited number of seats available, so if you are interested in attending, please send me an e-mail before THIS Friday at 5pm to hold a spot.  Details are below…

Employees are asking employers questions when; a claim is not paid, a generic drugs is substituted for brand, Prior Authorization questions are asked, there are delays in dispensing their drugs, or they are told that drugs will only be paid for and dispensed by certain pharmacies.

Clients are often faced with an employee that says “you can’t make me take these pills, or tell me where to shop”. We’ll help provide you with the right answer to share that will help to deal with those conversations quickly and efficiently.  The presentations also cover; navigating the “system” to help support staff, identifying tools that are available to assist employees, as well as patient support programs that can improve health outcomes.

Information and directions are below.  But let us know if you’re interested, and we’ll book a spot at no charge to you.


Have a youth that has a drug claim declined?

We have had some feedback from clients (very few) that their employees with dependent children age 24 and under are having issues with the new OHIP+ program.  This issue is caused when someone under age 25 is using what is called an EAP drug.  In the past, these drugs would normally be covered by the private employer benefit plan. The province is now covering this with OHIP+ as of January 1st, 2018.  This means that the private plans will NOT pay for these drugs until the province has declined coverage.

There is more information on the provincial website link below, as well as the list of the over 1000 EAP Drug ID Numbers (DINS) that need special application forms completed…



A look at the five-year forecast for drug plan cost increases

Employers will see private drug plan costs rise by about six per cent annually over the next five years, according to a prediction by a health-care research company.

Brad Millson, principal of health access and outcomes at IQVIA, presented the results of his firm’s 2017-21 forecast, produced in partnership with Innovative Medicines Canada, at Benefits Canada’s 2017 Face-to-Face Drug Plan Management forum on Dec. 14.

Ontario’s Bill 177 Brings Big Changes for Employer’s Workplace Safety Obligations

Close on the heels of the sweeping changes brought about by Bill 148, the Ontario government has enacted another set of changes to Ontario’s employment laws. Bill 177, the Stronger, Fairer Ontario Act (Budget Measures), 2017, is omnibus legislation that affects a number of Ontario statutes, including the Occupational Health and Safety Act (OHSA), as well as transitional updates to the Workplace Safety and Insurance Act, 1997 (WSIA).



A decision of the Ontario Divisional Court helps answer questions on how employers can handle employee medical notes or doctor’s recommendations that don’t seem quite right. In ‘Ontario Employers’ Right To Request Independent Medical Examinations’ at the Benefits and Pensions Monitor website, Laurie Jessome, a partner specializing in employment law and chair of the advocacy group at Cassels Brock, explains how in Bottiglia v. Ottawa Catholic School Board, 2017, the Divisional Court says employers do not need legislative or contractual authority to require that an employee submit to an independent medical examination as long as they have reasonable and bona fide grounds for requesting the examination.

excerpt from Benefits and Pension Monitor – ONLINE