The Trillium Drug Program, part 4: What advisors need to do

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In the fourth of a four-part series, Patti Ryan looks at the steps advisors can take to ensure their clients use Trillium to their advantage.

What can advisors tell their clients to minimize the impact of drug costs on their plans?

In terms of plan design, Tim Spark, president of RTM Benefit Partners in Toronto, suggests employers implement 10% to 20% co-insurance.

“That way, you have the opportunity to transfer part of the cost of the plan to the public system, because you can meet the deductible that’s required under Trillium that the employee has to pay.”

Employers should also be aware of the financial risks they’re accepting when they implement larger stop-loss amounts in an attempt to control costs, says Spark. “For example, if you have 500 employees, you may think a $25,000 stop loss is the right level, because you’re big enough, and what are the odds of getting many claims that are higher than that?

That thinking was sound when cancer drugs were the biggest claims. With hepatitis C, I’m saying to these businesses, ‘Let’s get down to a $10,000 to $15,000 level of risk, because if you get three hepatitis C claims, you’re at $75,000, and that’s significant.’”

What employers need to know
A key piece of information for employers is that they cannot apply to Trillium on their own or an employee’s behalf. Applications are available at pharmacies, and individual plan members need to fill them out themselves and submit them.

“When I mention Trillium, sometimes employers will say, ‘Send me this stuff and we’ll register,’” says Spark. “But that’s not how it works. This is all about motivating individual plan members to take care of it. If they don’t, employers will end up covering their share of the cost, which is usually anywhere from 80% to 100% of it.”

Communicating the complexities
Spark suggests employers adopt a proactive approach towards employee education about Trillium that does not single anyone out. Simply say that very expensive drug treatments are increasingly available, but could make it difficult for the company to continue providing comprehensive health benefits for all if employees do not do their part by approaching Trillium directly for coverage.

It’s important, says Spark, because hepatitis C may be only the tip of the iceberg. “How many more drugs like that may be coming?”

The bottom line
At the end of the day, says Dave Patriarche, president of Mainstay Insurance Brokerage Inc. in Thornhill, Ont., brokers need to work harder at educating employers, which he admits is no small task given the intricacies. The goal is to have provincial and private drug plans integrated so costs are fairly shared. This will involve coordinating drug plan costs based on Trillium’s current plan design.

“Trillium is not perfect—there can be payment delays—but if claims are adjudicated properly, then the number of large claims employers’ plans are being hit with will be dramatically reduced, and we’ll end up with much more sustainable drug and benefit plans in the long run.”

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