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How will oral cancer drugs affect your group benefit costs in Ontario?

Most of the new cancer drugs which Health Canada are approving for use in 2011 and 2012 are oral, versus in a vial – meaning that instead of chemotherapy treatments being strictly administered intravenously by a doctor, patients can now be given a prescription to pick up their oral cancer medication at their local pharmacy.

One well known pharamcy consultant has predicted that it will lead to significant increases in private plan costs.

Why should you care?

An intravenous cancer treatment done in a hospital is paid for by OHIP.

Who pays for oral cancer drugs dispesned at a pharmacy? Employer plans…unless the patient has applied to the Ontario Trillium Drug Programand is an ODB beneficiary.

Cancer drugs start at $30,000 per year and only go up from there. The American National Cancer Institute’s epidemiologists predict that 1 in 2 people born today will be diagnosed with cancer in their lifetime.

We don’t want those costs on your benefit plan. The last thing we want to do is come to you with an increase in rates upon renewal – remember that premiums are directly tied to how much was claimed in the prior year.

What can you do about it?

1. Educate your employees about the Ontario Trillium Drug Program or your respective provincial drug plan

  • The only way your employees will learn about Trillium is if they either hit their drug cap, and are told on-the-spot at the pharmacy to apply to the ODB; or,
  • Someone takes the time to educate them in advance (family doctor, pharamcist, oncologist, or employer)
  • We are always happy to come to your place of work to speak to a group or individuals

2. Structure your plan to force Trilium to become the payer

  • Put in a dollar maximum on drugs if you do not already have one
  • If you already have a dollar max, reassess if it’s the right level for your company
  • Make sure your co-insurance level is at 80% and not 100% (there is a technical reason why this is important to Trillium coverage, and does not negatively affect the employee as much as you would think)

Suggested Next Steps

Set up a meeting with your Beneplan account manager and we will come in to explain how to protect your plan against the imminent increases.