Bending the benefits cost curve

We continue our commitment to plan sustainability with new programs and technology.

Drug benefits are the highest cost for most plans. Our goal is to help plans stay sustainable by finding new ways to balance access to care, while addressing rising drug costs. Keeping both plan members and drug plans healthy is critically important. 

We successfully launched and enhanced several pharma programs in 2020:

Reference Drug Program (RDP) 

  • This program limits coverage to the most cost-effective drug in each therapeutic category. 
  • We’re balancing drug plan costs with maintaining therapeutic choices for plan members.

Transitioned our Preferred Provider Network (PPN) to a new provider, Express Scripts Canada

  • Our new PPN partnership continues to provide plan members with access to the specialty medicines they need.

Expansion of the Product Listing Agreement (PLA) program

  • Over $85 million in overall PLA savings in the first three quarters of 2020
  • Since the beginning of the program, we've brought over $240 million in savings to our plan sponsors and members.

We added online CBT and pharmacogenomics to our EHC plan offering. These two advanced therapies are helping plan members get better – faster and more efficiently. Read more about the programs details here.

To learn more about the research behind the program, read our Bright PaperFrom Pilot to launch: closing the gaps around access to mental care.  

Pharmacogenomics

Pharmacogenomic testing is an effective tool to help treat chronic conditions supported by such testing. This includes:

  • Mental health problems 
  • Type 2 diabetes
  • Cholesterol
  • Blood pressure / cardiovascular
  • Chronic pain

When plan sponsors add this to their Sun Life EHC benefits, plan members can claim pharmacogenomic testing costs when it supports their diagnosis. This can lead to a faster and more effective treatment path, and reduced absences from work.

Partnering to increase access to online cognitive behavioural therapy (CBT) 

Mental health claims continue to lead disability claims and impact plan costs. Online CBT is an effective therapy, especially for mild to moderate depression and anxiety. Early intervention with online CBT can help plan members stay at work while completing therapy. 

Sun Life has partnered with MindBeacon Health to offer plan members online CBT at a discounted price. 

This discount helps ensure that the cost of therapy remains at or below the coverage maximums of most plans. This reduces the barrier of out-of-pocket expenses for plan members seeking mental health care.

Both these therapies have been shown to help decrease duration of illnesses and severity of symptoms. Shortening claim duration can add up to significant savings and minimize disruption for organizations. 

Just the costs associated with replacing employee income are high. The average monthly benefit received by a plan member on long-term disability was $3,120 in 2019.1

1Based on Sun Life’s block of business. Average monthly gross benefit for LTD claim with approval date in 2019

Giving plan members the tools and information they need to make smart choices in benefit spending. Better benefit spending is an important part of cost containment. 

Savings through the Lumino Health Centre 

The Lumino Health Centre offers resources to support plan members’ wellness goals. Two areas that offer cost savings are helping to keep plans sustainable: 

  • Lumino Provider Search: Filters allow more refined searches based on cost and ratings. Cost indicators ($/$$/$$$) for each provider based on plan member claims history. 

    Choosing a lower-cost provider can save the plan member money through lower co-payments and lower claims costs. This can help plan members maximize their coverage over time, thus leading to plan sponsor savings.

    Coming in spring 2021: new provider specialties

    1. Social worker  
    2. Psychotherapist
    3. Clinical counsellor
    4. Registered dietitian 
    5. Occupational therapist/ergotherapist 
    6. Audiologist 
    7. Speech therapist 
    8. Kinesiologist
    9. Athletic therapist

  • Lumino Resources & Offers: a central hub of health resources. It includes exclusive discounts, free resources and tools from leading providers and retailers.

Ella educates plan members on cost-effective options

Ella’s smart tips and nudges to plan members help them make healthy, cost-effective choices, like picking a pharmacy with lower dispensing fees. As of October 2020, Ella has offered over 40 million suggestions or ‘nudges’ to plan members.