Highlights of the legislative and industry updates in 2013

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Federal and provincial legislation and budgets, as well as changes to provincial health plans, can have a considerable impact on group benefits plans. We communicate these changes to you via Focus Updates during the year.

The information below provides a useful province-by-province recap of the changes we have seen in 2013. Note that the topic of generic drug reform, which impacts most provinces, appears at the end of this communication, to avoid repetition.
 

ALBERTA

Reinstated Prescription Drug Allowance for Pharmacies as of April 15, 2013

As of April 15, 2013, the government reinstated for one year a $1.00 per prescription allowance to let pharmacies transition their business model.

For more information, refer to Focus Update #390.

Alberta Pharmaceutical Strategy – Update on Generic Pricing

In addition to the April 1, 2013, announcement that all provinces (except Quebec) reduced the price of the top six generic drugs to 18% of the brand named drugs (see Generic Drug Reform at the end of this communication), Alberta released further details. The Alberta government's new 18% price demand targets the 2,804 "interchangeable" drugs, communicating to suppliers the price the province is prepared to pay as of May 1, 2013. However, drug companies are not bound by the province's demand, and instead can submit prices at a variety of rates. If the government and a supplier cannot agree on a price, the province can either grant an exemption, or it can stop covering the drug. Provincial policy is that no drug is delisted unless an alternative supply is available.

For more information, refer to Focus Update #399.

Alberta’s Insulin Pump Therapy (IPT) program

Since June 1, 2013, the government of Alberta offers coverage of insulin-infusion pumps and some pump supplies to patients of all ages with Type 1 diabetes. Patients must be referred to the program by their physician or nurse practitioner and must meet the eligibility and clinical criteria to be covered under the new Insulin Pump Therapy program. While a few other provinces have had insulin pump programs in place for some time now, Alberta is the first province to offer pumps without an age restriction.

The Insulin Pump Therapy (IPT) program will also cover the costs of some pump supplies for up to five years for persons already using a pump. Existing users must be referred to the IPT program by their physician or nurse practitioner and will need to be assessed to ensure they meet the eligibility and clinical criteria for the program. 

For more information, refer to Focus Update #412.

Changes for some massage therapy claims in Alberta made effective January 1, 2014

Since January 1, 2014, claims for services of a massage therapist in Alberta who belongs to the NHPC can only be considered eligible for reimbursement if that practitioner has the required hours of training (2,200 hours of formal training), has passed the Competency Equivalency Exam (CEE), or been exempted from this exam.  

Plan members with practitioners who belong to other associations in Alberta recognized by Sun Life are not affected by this change. These associations are the:

  • London and Counties Society of Physiologists
  • Massage Therapist Association of Alberta (MTAA)
  • Remedial Massage Therapists Association (RMTA)

For more information, refer to Focus Update #423.

BRITISH COLUMBIA

GST/HST changes

On April 1, 2013, British Columbia (BC) implemented changes to the GST/HST:

  • Eliminated the harmonized sales tax (HST) at a rate of 12%
  • Returned to a provincial sales tax (PST at 7%) and federal goods and service tax (GST at 5%) system.

Contracts that were charged the BC HST are now subject to GST only.

For more information, refer to Focus Update #383.

MANITOBA

Provincial retail sales tax rate increase

The Manitoba government announced in their 2013 budget that the provincial retail sales tax


(RST) will increase from 7% to 8%, effective July 1, 2013. This rate increase impacts group insurance premiums for plan members who reside in Manitoba on the following coverage:

  • Life
  • Accidental death & dismemberment
  • Disability (short-term and long-term)
  • Critical illness
  • All creditor insurance

Extended health care and dental coverage are exempt, as are administration services only (ASO) arrangements.

For more information, refer to Focus Update #398.

NEW BRUNSWICK

New Brunswick Generic Drug Reform

The New Brunswick government in their 2013 budget announced the following generic drug pricing changes:

  • Since June 1, 2013, there is a reduction from 35% to 25% on the reimbursement prices of solid oral dosage from generic drugs of the equivalent brand-name.
  • Similar to Ontario and British Columbia, prices of non-solids will be set at 35%.
  • The NB government also announced that exceptions were put in place for this change.

For more information, refer to Focus Update #399.

Introducing New Brunswick’s Prescription and Catastrophic Drug Insurance Act and the New Brunswick Drug Plan

 On December 10, 2013, the province introduced their Prescription and Catastrophic Drug Insurance Act, to provide residents with access to a government-sponsored prescription drug insurance plan.

This prescription drug insurance plan will be jointly funded by the government and plan participants in accordance with their ability to pay.

Starting on May 1, 2014, residents will have voluntary access to the plan.

Starting April 1, 2015, all residents will have to be a member of a prescription drug plan with benefits comparable to the government-sponsored plan, or be enrolled in the New Brunswick Drug Plan.  

As this drug plan will continue to evolve over the next several months, Sun Life continues to monitor the developments and will communicate when appropriate.

For more information, refer to Focus Update #425.

NEWFOUNDLAND and LABRADOR

Newfoundland and Labrador Generic Drug Reform

The Government of Newfoundland and Labrador announced the following generic drug pricing changes in their recent budget:

 Effective July 1, 2013, the government will be reducing the cost of generic drugs to 25% of the equivalent brand-name. Please note that in an earlier communication (see the end of this document), we confirmed the pan-Canadian generic pricing update, where provinces and territories agreed to decrease the cost of the top six generics to 18% of brand, effective April 1. This additional announcement from the Government of Newfoundland and Labrador excludes these top six generics (which will continue to be priced at 18% of brand).

For more information, refer to Focus Update #399.

NOVA SCOTIA

Nova Scotia’s Insulin pump program

On April 4, 2013, Nova Scotia announced a new program, which began on September 16, 2013.

The program provides provincial funding for insulin pumps and pump supplies for children aged 18 or younger with Type 1 diabetes. Young adults between ages 19 and 25 can also apply for coverage of their insulin pump supplies. Applicants need to meet all criteria to be eligible for funding.

Funding through the program is based on family income, size and medical eligibility; therefore not all successful applicants will receive the same funding. This program was designed to assist low income families and provide coverage to those who would otherwise not be able to afford an insulin pump or pump supplies. More details are available via the Nova Scotia website at http://novascotia.ca/DHW/insulin-pump-program.asp

For more information, refer to Focus Update #412.

ONTARIO

Updates to the Regulated Health Professions Act, 1991

  • The practice of kinesiology is now a regulated profession in Ontario since April 1, 2013, under the Regulated Health Professions Act, 1991 and the Kinesiology Act, 2007 and supporting Regulation.
  • The College prepared a list of licensed practitioners who are recognized as meeting the regulatory requirements.
  • Only those kinesiologists who appear on the list are considered eligible providers for claims reimbursement in Ontario. Even though past claims from a kinesiologist may have been covered, future claims from the same practitioner are being declined if the kinesiologist is not registered and on the list issued by the College.

For more information, refer to the Special Edition Focus Update dated April 18, 2013.

Acupuncture practice in Ontario

On April 1, 2013 the Transitional Council of the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario published a list of practitioners who are recognized as meeting the regulatory requirements for practicing acupuncture in Ontario. Only those acupuncturists who appear on the list are considered eligible providers for claims reimbursement in Ontario.

For more information, refer to Focus Update #385.

PRINCE EDWARD ISLAND

PEI’s new Catastrophic Drug Program

In October of 2013, PEI announced their new Catastrophic Drug Program. The focus of this new drug program is to assist those islanders who do not have drug coverage or are experiencing high drug costs not covered by their private or other public insurance.

To some degree, islanders who have large prescription drug expenses may benefit from this program;  however the program is intended to be payer of last resort and only kicks in when the individual (whether they have private coverage or not) is truly out-of-pocket. Therefore private coverage is still first payer and thus you as plan sponsors will not experience any cost savings. Still, this program can be of value to your plan members with high drug costs and out-of-pocket expenses. As such, you may wish to promote the program to your plan members.  

For further information, please visit the government site at http://healthpei.ca/catastrophic

GST/HST changes

On April 1, 2013, Prince Edward Island (PEI) introduced the harmonized sales tax (HST) at a rate of 14%. Contracts that were charged GST and the governing law provision in the contract is PEI, are now subject to the HST at 14%.

For more information, refer to Focus Update #383.

QUEBEC

Changes to QPP that impact disability benefits

Effective January 2013, Quebec’s Bill 39 amended the Act respecting the Quebec Pension Plan and included changes that allow an individual who is in receipt of retirement pension, to apply for an additional disability pension amount.

Before this date, if an individual, aged between 60 and 65 and in receipt of a QPP retirement pension, became disabled within six months of the first payment date of the retirement pension, they could apply to have the retirement pension switched to a disability pension which is normally a higher amount.

Since January 2013, individuals who are outside of the six month time limit to change from QPP retirement to QPP disability pension can now apply to receive an additional amount for disability. If approved, the amount the plan member would receive from QPP would be a combination of retirement and disability pension. 

To be eligible for this additional disability pension amount, the plan member must have contributed to the Quebec Pension Plan for at least four of the six years preceding the date of disability. The additional disability pension is a set monthly amount that is paid to age 65. The amount for 2013 was $453.49 per month.

Standard Sun Life contracts with disability coverage offset income provided to plan members for the same or subsequent disability. Depending upon the situation where the disability coverage allows for the offset of QPP disability pension only, we ask that the plan member:

  • switch their retirement pension to a disability pension, or
  • apply for the additional QPP disability pension amount

For more information, refer to Focus Update #397.

Quebec Smoking Cessation Aids Maximum

The Régie de l'assurance maladie du Quebec (RAMQ) announced a reduction of the maximum amount for smoking cessation aids and products to $700 for the 2014 calendar year. This decrease takes into consideration current drug therapies and reflects the reduction in cost for these products.

For more information, refer to Focus Update #399.

SASKATCHEWAN

 Saskatchewan Dispensing Fees

The Saskatchewan Ministry of Health announced the completion of negotiations between the Pharmacists’ Association of Saskatchewan (PAS) and The Drug Plan and Extended Benefits Branch (DPEBB). On May 1, 2013, the dispensing fee increased from $10.25 to $10.75. Our systems were updated accordingly to reflect this dispensing fee change.

For more information, refer to Focus Update #399.

FEDERAL

 Employer contributions to a group sickness or accident insurance plan are a taxable benefit to employees, effective January 1, 2013

Contributions paid by employers towards a group sickness or accident insurance plan will be at taxable benefit to the employees. While employer contributions paid towards a wage loss replacement plans, such as short-term and long-term disability are not impacted by this legislation; employer contributions towards coverage like accidental death and dismemberment and critical illness are affected.

For more information, refer to Focus update #374.

Increase in EI maximum insurable earnings

The federal government announced the 2013 Employment Insurance (EI) premium rates and maximums:

(EI) premium rates and maximums. New rates effective January 1, 2013
Maximum insurance earnings

$47,400 

Maximum weekly EI benefit

 $501


This increase affects Short-Term Disability (STD) plans where:

  • The maximum STD benefit is based on the EI maximum weekly benefit ($501 for 2013), or
  • The EI maximum earnings amount is used to calculate the STD benefit.

We updated our systems so that STD claim payments reflect the increase in EI maximum insurable earnings threshold, and premiums reflect the increase in the STD benefit amount payable.

For more information, refer to Focus Update #373.

GENERIC DRUG REFORM

On April 1, 2013, all provinces except Quebec, as well as the three territories, reduced the price of the top six generic drugs to 18% of the brand named drugs. Details are outlined below.

The six generic drugs to be priced at 18% of brand are:

  • Atorvastatin (generic version of Lipitor) – used to treat high cholesterol
  • Ramipril (generic version of Altace) – used to treat blood pressure and other cardiovascular conditions
  • Venlafaxine (generic version of Effexor) – used to treat depression and other mental health conditions
  • Amlodipine (generic version of Norvasc ) – used to treat high blood pressure and angina
  • Omeprazole (generic version of Prilosec) – used to treat a variety of gastrointestinal conditions
  • Rabeprazole (generic version of Pariet) – used to treat a variety of gastrointestinal conditions

For more information, refer to Focus Update #390.

Questions?

Please contact your Client Service Administrator at 1-877-786-7227.