beneplan - benefits law & admin workshop - december 1 2015 - mississauga, ontario, canada

The Beneplan Co-operative

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Benefits Plan Administrator’s Workshop !

December 1, 2015

2015

Beneplan Points of Contact

Vince Principato, Partner Patricia Thomas, Benefits Consultant Evelyne Mitskopoulos CNP, Director of Wellness Johnathan Eagleson, Benefits Associate Yafa Sakkejha, GM

• 9:30am - Overview of Renewal Calculations

• 10:00am - Plan Administration Guidelines

• 10:30am - Dr. Prouse PhD: Study on Personalized Medicine

• 10:45am - Evelyne Mitskopoulos CNP: Wellness in the Workplace

• 11:30am - Martin Walker, LLQP, CEBS, The Co-operators

• 12:00pm - Lunch

• 1:00pm - Davies Howe Partners LLP on Benefits Law & Liability

• 2:30pm - Helen Stevenson, CEO, The Reformulary Group

• 3:30pm - Prize Draw and Adjourn

Agenda

Think like an owner…

…of an insurance company

Mutual.

Remember: Insurers & Brokers are paid a % of the float !

The leftover profit goes to the members

The system is not incentivized to reject the maximum # of claims…

The system is incentivized to approve the maximum # of claims.

Employees Employers

• In FY 2014, 70% of member-owners received dividends

• 30% of members had deficits absorbed by the co-operative — i.e. by you!

• Our role is to minimize deficits as much as possible.

Patronage Dividends

Your Board sets policies designed to protect the pool: your profits.

Board at the 2013 AGM

Renewals How are your rates calculated?

• Calculated at Beneplan for health & dental

• Based on the following:

• Weighted average of last 3 years’ usage

• Inflation: 6% Dental; 11% Health

• No IBNR built-in (taken from dividend)

• +Expense factor for fees, commissions, and taxes (differs by company size)

Rate Setting: Health & Dental

• TLR is a representation of the target profit that the benefits company would retain.

Target Loss Ratio

0

25

50

75

100

TLR

$75 towards claims

$25 towards fees, commissions, taxes

$100 in premiums

• In your company, compare it to mark-up vs margin on COGS

Target Loss Ratio

0

25

50

75

100

TLR

$75 is the Cost of Goods Sold

$25 is the margin

$100 cost of shoe

…so what’s the mark-up on COGS? =75/25, or 33%

• Which is better for the client? A TLR of 75% or a TLR of 60%?

Target Loss Ratio

0

25

50

75

100

TLR0

25

50

75

100

TLR0

25

50

75

100

TLR

• Which proposal would you take?

Target Loss Ratio

Blue Trust Insurance

True North Insurance

Monthly Premium $3,000 $3,000

Target Loss Ratio 85% 75%

• Now which one would you take?

Target Loss Ratio

Blue Trust Insurance

True North Insurance

Monthly Premium $3,000 $2,000

Target Loss Ratio 85% 75%

Year H&D Premium

H&D Claims

# Months

Fam Rate $

Usage $

Weight-ing Pop.

2015 100,000 60,000 12 150 90 70% 55.5

2014 90,000 70,000 12 145 112 20% 51.7

2013 85,000 50,000 12 142 83 10% 49.8Dental inflation 6%Health inflation 11%

Fees & Taxes 12%

Broker commission 5%

These elements help determine the rate

• Change in health of employees

• Rapid population change

• Turnover

• Average age

• Anti-selection

What affects your consumption?

• Low-Risk and High-Risk Tiers

• High-risk (unlimited drug plan)

• 7% to 15% depending upon the carrier.

• Low-risk (drug cap of $10,000 or less)

• $1 to $2 per Single; $2 to $4 per Family.

• Not EP3 Eligible

• Stop-loss pool is experience-rated - so you pay less if the pool does well.

Rate Setting: Pooling Charges

• Life, AD&D, LTD, CI

• Done at the insurance carrier

• Based on demographics

Rate Setting: Pooled Benefits

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Day-to-Day Administration

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Please let us know when….

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• New employee

• Salary change

• New dependent

• Change of address / beneficiary

• Change to coverage (Single / Family)

• Someone is not actively at work (sick / other leaves)

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Late Applicants

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Who is Eligible to Join Your Benefit Plan?

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Eligibility to Join the Plan

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• Active employees

• Employed by the employer

• Working on a regular permanent basis

• Working full-time for a minimum # of hours

• Not seasonal

• Member of an eligible class of employees

• Insured under a provincial government health insurance plan

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Eligibility to Join the Plan

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• Dependents

• Your legal spouse

• Common-law spouse after 12 months of cohabitation

• Your natural children

• The natural children of your spouse

• Children who are in your guardianship (need legal docs)

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Who is not eligible to join?

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• Inactive employees

• Retired / independent contractors

• Someone employed by a different employer (no common ownership)

• Cannot be your cousin who just came to Canada and is not an employee

• Not working on a regular permanent basis

• Temp workers / part-timers

• Not full-time for a minimum # of hours

• An employee who is not covered under a Canadian provincial health plan.

• Parents / Grandparents / Grandchildren

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Independent Contractors

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• Never add an independent contractor onto your benefit plan

• The CRA will deem them to be an employee, and therefore, make you and the individual pay back-owed taxes and penalties

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“What if I have many short-term contract employees who I want to cover?”

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• Let us know the nature of their work, and if this is an essential part of your workflow

• If you want to offer them benefits, you must:

• Enrol all employees in this class, not only those who ‘choose to join’

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Participation

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Quiz: Should you give employees the choice to join the benefit plan?

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Or should it be mandatory of employment?

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It should be mandatory of employment.

!

In fact, if the insurer finds out that a minimum # of

participation is not achieved, they may not

agree to underwrite the risk.

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How is ‘participation’ defined? !

Enrolled in all pooled benefits Life, AD&D, WI, LTD, CI

Enrolled in health & dental; or, Opted out of health & dental only if they have alternate coverage — not because they don’t want to join!

http://beneplan.ca


“But my employees pay 50% of the premiums! I can’t force someone to pay this amount if they don’t want to!”

Actually…you can, and you must. Do you let employees opt out of other deductions such as CPP?

You can make the benefit plan mandatory of employment. !

If you don’t want to have this discussion, don’t have employees share the cost on payroll - instead, put in cost-sharing at the POS

like co-pays or deductibles.

http://beneplan.ca


“Ok…but I’ve been operating for years under this assumption. If they join now, they will be late applicants.”

Let us know and we can ask for approval of an ‘open enrollment’ period if you agree

to enrol all employees onto the plan.

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Patricia Thomas: Benefits Audits

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Refusal of Benefits Form Spousal signatures are now required !

Require an updated form every year !

Do these forms stand up in court?

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NEMs Non-evidence maximums !

Do your employees know what this is, and have they applied?

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LTD Earnings definitions !

Does your insurance policy earnings definition match your company’s practices? !

Usually coverage is only for base salary - not bonuses, dividends, commissions or overtime.

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Booklets !

Do all employees have the most up-to-date policy booklet displaying coverage and guidelines?

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Plan Administrator Liability Coverage !

Does your business liability insurance have a provision for plan administration liability? If not, add it!

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Claims !

If you are processing claims on behalf of your employees, stop! !

You don’t want to be accused of a breech of privacy, or a termination because you knew the employee was sick because you saw their claims.

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Questions about Coverage !

Have the employee call the call centre, instead of asking you, due to privacy. !

The Co-operators 1-800-667-8164 Standard Life / Manulife 1-800-499-4425 Green Shield Canada 1-888-711-1119

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Catastrophic Drug Coverage !

Ontario Trillium Drug Program

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MF/Situation: An employee has been prescribed a drug costing $50,000. !

Your benefit plan has a 20% copay = $10,000. !

The employee’s salary is $40,000. Now what?

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Sick Leaves.

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Short-Term Disability

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“Boss, I broke my leg! I need 2 months off.”

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“Boss, I need to take some time off. Medical leave. Maybe 2 weeks, but not sure. I can try my best to work from home.”

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Do you… A) Pay them full salary? B) Pay them in full but

encourage them to work from home?

C) Send them to EI but make a one-time exception to pay them the difference.

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If you don’t have a WI/STD plan: !

- Set up a SUB plan as a placeholder

- A SUB plan allows you to top-up their EI payments without any claw-backs

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Short Term Disability / WI

0

25

50

75

100

WI0

25

50

75

100

WI

Premiums

Claims


EI Premium Reduction Program

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Long Term Disability !

Let the employee deal with the insurer directly: privacy, liability !

Don’t let them work or earn income during the elimination period

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Benefits: Terminating an Employee

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Scenarios !

- Employee quits - Terminated with cause - Severance - Let us know in advance:

LOA

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Pharmacogenetics - Personalized Prescribing

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Personalized Prescription

Plan

Your medications should be helping you, not hurting you

S Adverse Reaction

S Effectiveness

We are all unique, and so is the way we metabolize medications

Main factor that predicts medication response: Genetics

Case Study – Sarah is an employee who has severe clinical depression

Case Study – Jane is an employee who has been diagnosed with breast cancer

What do both of these case studies have in common?

What do both of these case studies have in common?

Incompatibilities to medication that make it difficult to

determine the right drug at the right dose the first time

What is P3?

S P3: Personalized Prescription Plan

S An employee benefit that utilizes a genetic test to predict medication compatibility S Not a test to predict disease risk S Confidential (information does not go to the

insurance company) S Similar to an allergy test (information cannot hurt

you)

Beneplan Pilot Study – How does it work?

1. Enroll your company in Beneplan Pilot Study

S At no cost to members S Limited 6 month duration

2. Eligibility

You are eligible to requisition a P3 test if you are on a medication that we test for

S We test for over 900 brand names of medications S Psychiatric

S Oncology

S Cardiology

S Gastroenterology

S Pain

S Rheumatology

S Infectious diseases

S See the complete list of drugs at: www.personalizedprescribing.com

http://www.personalizedprescribing.com

S

Questions?

Other Questions?

S Call: 1 (844) 943 – 0210

S Email: [email protected]

S 100% Confidential

S See Policy Letter in Beneplan Booklet for more info

S

Thank You!

FDA on Adverse Drug Reactions

We are all unique, and so is the way we metabolize medications

Evelyne Mitskopoulos:

Wellness in the

Workplace

Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc 1 (800) 387-‐1670 x 226 [email protected]

Disclaimer

The advice given in this presentation is the result of recommendations from medical doctors and researchers in the allopathic and complementary health community. All recommendations are based on clinical evidence and studies which were published in peer-‐reviewed journals. Any additional advice expressed in this presentation is opinion. Prior to making any changes to your diet, taking supplements or exercising, please consult with your medical doctor.


!

Warning: The information you are about to receive may cause you or your employees to enjoy their Job.


Root causes that affect work performance

!

• Lack of physical activity • Inadequate nutrition (diet high in fat, starch & sugar)

• Chronic Stress


Barriers affecting Employees

1) Lack of Time !

2) Lack of Motivation !

3) Lack of Energy


What can we do at the Workplace?

• Healthy food options at work • Health spending accounts e.g. exercise classes • Employee Assistance Program (EAP) • Employers need to be flexible with Employee e.g. Time to allow them to attend exercise class • Rewards for accomplishments e.g. Prizes to walk to work / weight loss competition

• Health day exhibition at work or tickets to events


How to get Started?

• Surveys, lunchtime meetings, posters • Health Risk Assessments conducted by companies in-‐house (Medisys)

• Wellness committee with management support • Follow up in 6 mos. to measure effectiveness


• Know your demographics • Know your attendance rates • Know your Data -‐ drug claims experience to see top 5 drugs used e.g. antidepressants, metabolic syndrome drugs, painkillers

• Know your employees. What are their needs, attitudes and preferences?


What is the Cost of Doing Nothing?

• Increased Employee turnover • Reduced efficiency & productivity • Higher stress • Every $ spend on wellness generates $3-‐5 return on investment (Source: Benefits Canada )

• Giving employees tools to achieve their goals and stats show 88% success rate (Benefits Canada)

• Budget – Employer to support and employee can raise funds such as dress down day $2.00


Protect our Brains

Reduce sugars and white refined carbs. These foods “caramelize” the coating around our brain, as well as collagen throughout the body. (Source: Optimum Nutrition for the Mind) !

Add lean proteins (fish, eggs, whey protein powder contain amino acids that are building blocks for brain chemical messengers & stabilize blood sugar levels)


Omega 3 Fatty Acids (3,000 mg daily) • Decreases inflammation in the brain & central nervous system

• Ensures adequate healthy fats to form the outer coating of neurons, and helps prevent abnormal plaque buildup that contribute to several neurological conditions and impair memory (Source: Optimum Nutrition for the Mind, Patrick Holford)


Sleep and Melatonin

• Deep sleep (REM), 7-‐9 hours nightly for cognition, memory and tissue repair

• Melatonin – before bedtime 3 mg, regardless of sleep patterns, is a powerful free radical scavenger and anti-‐inflammatory for the brain. – Most important nutrient for prevention of Dementia and Alzheimer’s (Source: Mind Over Matter – Women’s Brain Health Initiative)


Meditation

• Increases delta wave activity (calm brain wave in stage 4 sleep) • Inhibits cortisol production • Improves blood flow • 15-‐30 minutes/day for 8 wks • Improves hippocampal activity (key area of brain that shrinks in dementia)

• Improves short-‐term memory, focus, cognitive function, neural connectivity & transmission

• (Source: Mind Over Matter – Women’s Brain Health Initiative)


Sitting Disease

• Canadian adults spend ¾ of their waking hours each day sitting or reclining & children 2/3 being sedentary

• Body’s tissues, organs and metabolism aren’t engaged, heart, lungs & muscles go into hibernation and atrophy

• Simply standing up over 30 times a day is a powerful antidote to long periods of sitting and is more effective than walking -‐ it’s how often you interrupt that sitting that is GOOD for you

• Ex: housework, gardening, cooking, photocopier, and even just standing up every 10 minutes


Vitamins – an essential part of healthy living

• Vitamin C – strengthens blood vessel walls, prevents infection & aids in body’s recovery

• Vitamin D – “sunshine vitamin”, strengthens bones (calcium absorption), increases immune system, brain health

• B Vitamins – helps to regulate body’s energy, blood sugar & antioxidant mechanisms. For strong immune system, red blood cell & antibody formation, vision & healthy skin

• Vitamin E – body’s defense against illness and disease, and chronic stress


Vision & Eye Twitches• Take frequent eye breaks every 20 minutes • Reduce glare from windows or lights by repositioning computers and

using dimmer lights • Use a screen filter, or control screen contrast to cut down on glare • Wear sunglasses or hat in bright sunlight • Discuss your medications with Eye doctor as they can further damage

health of your eye (especially epilepsy & psychosis drugs) • Use moisturizing eye drops to lubricate irritated eyes • Sleep adequately. Reduce caffeine and alcohol. Do not smoke. • Compress of warm water sterile pad


Scalene

• Muscles on side of neck • Also known as a group of respiratory muscles • They respond or react to the breathing pattern • Necessary for your diaphragm to go up and down with inhalation and exhalation

• Taking short breathes due to stress response inhibits diaphragm movement and scalene tighten

• When tightened can cause headaches, neck pain and over time discs clamp down causing degenerative disc disease


Stress & Anxiety


Laughter – What a way to Go!


Why is Nutrition so Important? Now vs 100 years ago…

Less Nutrients available because: • Soil depletion • Artificial fertilizers • Sterile soil • Fruits & vegetables picked unripe • Transportation & storage of foods degrade • Irradiation • Processed/junk foods • Less raw foods, more cooked • Poor digestion & absorption


When all else fails here is your prescription…


To book a wellness lunch & learn at your company, please contact: !

Evelyne Mitskopoulos CNP [email protected] 1-‐800-‐387-‐1670 x226 !

There is no charge for members of the co-‐operative.

mailto:[email protected]


Martin Walker - The Co-operators Life

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LUNCH: 12:00 TO 1:00

DAVIES HOWE PARTNERS LLP


Reformulary Results 2015 Average - Beneplan block April 1 2015 to October 31 2015 n=2,134 employees and dependents

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Reformulary

Generic Substitution

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Click to edit Master title style

© 2015 Reformulary Group. All rights reserved. Proprietary and confidential. For Reformulary and client use only

!~ Overview Presentation – 1 December 2015 ~

!Beneplan: Annual Plan Administrator's Workshop


© 2015 Reformulary Group. All rights reserved. Proprietary and confidential. For Reformulary and client use only �118

A Lesson in Winning Drug Plan Design with Reformulary

✓ YEAR 1 SAVINGS: drug spend decrease to $75,300

✓ YEAR 2 SAVINGS: drug spend deceased further to $72,800

✓ ENGAGED EMPLOYEES

Case Study

Restaurant Chain ✓195 lives ✓$83,000 drug plan spend pre-‐Reformulary

✓Implemented the Reformulary in 2013 !!

RESULTS

28%savings

“We recognize our drug plan as an investment in the overall health and well-‐being of our people. Our drug plan encourages our employees to be engaged and make sensible choices about the prescription drugs they are taking.”

“A benefit plan that reflects our culture is important… and a good prescription drug plan is a big part of it.”



Impact of new Hep C drugs on actual employer plan

✓ SAVINGS: Net of dispensing fee, plan spend was $1.5 million

✓ HEP C: Increase in hep C spend, from $476 to $176,000 for 0.07% of members

✓ MANAGE: 16.1% savings offset increased specialty drug spend…

Case Study

B2B Employer Plan ✓2,200 lives ✓$2 million drug plan spend pre-‐Reformulary ✓$111,919 spent on biologics for 0.23% of members

✓Implemented the Reformulary in 2014 !!

RESULTS

7.4%net savings



The case for a smarter drug plan

1. Higher cost drug claims are having a material effect on insurers and employers, with employers carrying most of the incremental increase through increased pooling rates

!2. When drug plans are well-‐designed, employees can become informed and involved, and make choices consistent with contributing to the long-‐term sustainability of the plan

!3. Drugs are the most expensive benefit in your health benefit plan; current drug plans are not providing maximum value for money



The Reformulary

The Reformulary® is an innovative “formulary” (or list of drugs), built based on evidence. Our formulary uses tiers and co-‐pays to promote drugs that provide the best healthcare value. By encouraging employees to use similarly effective drugs that are the most affordable, this ensures long-‐term sustainability of your drug plan

!

Clients have realized savings of between 9% and 15% in drug spend

Our partners

Other channels



1. We do the homework

We review all drugs, and we actively monitor new drugs coming to market !Each drug on our formulary has been evaluated by an impartial & independent Expert Committee, comprising practicing physicians and pharmacists. They evaluate: •Clinical effectiveness

•Cost-‐effectiveness

•Real-‐world evidence (patient experiences in the real-‐world)

!Our evidence-‐based review process is more than 4 years old. We manage it using an international patent-‐pending process

Based on this evidence-‐based

review, we categorize drugs as preferred and non-‐preferred, with

different co-‐pays…

WHAT WE DO (behind the scenes)



Drugs that offer the best healthcare value, and are always the most affordable

(lowest member co-‐pay)

Preferred drugs (tier 1)

Drugs that provide less healthcare value than

preferred drugs.

For every non-‐preferred drug, there is a clinically similar alternative on tier

1 at lowest co-‐pay

Non-preferred drugs (tier 2)

Non-preferred drugs (tier 3)

Drugs that provide the least healthcare value, and have the highest member co-‐pay.

For every non-‐preferred drug, there is a clinically similar alternative on tier

1

Preferred and non-‐preferred drugs



High cost specialty drugs are reviewed by our Expert Committee. We prepare detailed clinical criteria based on evidence, as to which drugs are most appropriate for which groups of patients. Drugs such as:

!Sovaldi | Harvoni | Vimizim | Kalydeco | Inflectra | Praluent* | Repatha

!These drugs require prior approval, meaning that members must meet the specific clinical criteria in order to be approved for coverage

Impactful management of specialty drugs

* Not yet approved in Canada; will be reviewed by our Expert Committee and likely only available via Special Authorization



Impact of one drug (PCSK9 Inhibitor) on total plan costs over 3 years

$22,974$23,384

$31,412

$229,792

$223,845

$314,116

$459,484

$467,698

$628,231

37%INCREASE



All-‐in-‐One

Benefit from our negotiating power

!

Generic substitution

Therapeutic alternatives

Communication tools, including DrugFinder

Special authorization for specialty & high

cost drugs

2. Employer communicates just one change

Quantity limits; Step therapy

!

WHAT YOU DO



To ensure a smooth transition, plan members get access to these engagement tools …

We make it easy for people to switch

Dr Mike video

Most members are not impacted by moving to the Reformulary



Tells employees exactly what drugs are covered, on which tier, and at what co-‐pay



3. Best-‐In-‐Class Experience & Results.

Company Drug spend Number of claimants Plan savings Generic penetrationReturn on Investment

(ROI)

Employer A $ 5,264,207 10,779 9% 83% 1711%

Employer B $ 7,043,802 18,305 9% 82% 1141%

Employer C $ 75,272 195 28% 65% 200%

Employer D $ 411,288 850 9% 81% 473%

Employer E $ 4,968,283 9,467 7% 82% 1293%

Employer F $ 1,495,065 3,070 18% 79% 1650%

Employer G $ 428,693 1,067 8% 79% 401%

Employer H $ 90,411 218 9% 81% 160%

Employer I $ 219,582 543 39% 77% 2346%

Notes Number of claimants includes employees and dependents that made a claim Savings percentage based on Per Member Per Month (PMPM), based on drugs tiered on the Reformulary Generic penetration refers to rate at which generic drug is substituted (dispensed) in place of the original brand name drug Generic fill rate refers to the number of prescriptions for generic drugs as a percentage of all prescriptions dispensed Plan members taking preferred drugs refers to the percentage of prescriptions by members for preferred drugs Return on Investment (ROI) is calculated as the cost of subscribing to the Reformulary, minus the savings, divided by the cost

WHAT YOU GET



Our offerings

What: Interactive tool for members to look up preferred & non-‐preferred drugs, and drug alternatives | Enables more affordable choices for Canadians !!Who: Offered to all Reformulary & Reformulary Select clients

What: Same great formulary | Delivers meaningful savings | Preferred (no or little co-‐pay) and non-‐preferred drugs (higher co-‐pay) | All members grandfathered on implementation so no member impact | Access to DrugFinder to encourage member behavior change !Who: Small to medium businesses; association plans; unions

What: Evidence-‐based formulary | 100% track record of delivering savings to clients (typically 9 to 15%) | Preferred (no or little co-‐pay) and non-‐preferred drugs (higher co-‐pay) | Personalized communication to members & access to DrugFinder successfully effects member behavior change !Who: Corporate Canada



Potential next steps

ReModel – quick estimate of your potential savings based on implementing the Reformulary; models top 100 DINs (no fee)

Full Model – detailed, claims level modelling of potential savings & member impact based on implementing the Reformulary (fee)



1. All drugs on the Reformulary– and new drugs coming to market – are reviewed by experts.

2. Our Expert Committee is credible, unbiased and independent.

3. The Reformulary includes all drugs.

4. We already found the best price.

5. We create informed consumers.

6. Our results speak for themselves. !!

There is no other offering in the market as comprehensive and proven as the Reformulary.

In summary…



Appendix



Hammond Power Solutions:

Innovation in its drug plan design

!Hammond Power Solutions is the largest manufacturer of electrical dry-type transformers and related engineered magnetic devices in North America. A family-owned business for over 97 years, Hammond Power has grown into an industry leader with 1,400 employees, 12 manufacturing facilities and 8 regional warehouses. !“Being more open to change and looking for better ways” – innovation – is one of five core values at Hammond Power. That innovation extends into employee health benefits, whereby the company provides benefits to both its union and non-unionized staff, including extended health care and prescription drug benefits. Hammond Power was looking for better ways to provide prescription drug benefits, offering the best possible value while encouraging members to become more involved in their drug and health decisions. !In October 2014, Hammond Power seamlessly implemented the Reformulary® within their salaried employees. Marta Dawe, Human Resource Manager, commented on the smooth implementation with members actively using DrugFinder. She states, “We are very pleased overall with the implementation of the Reformulary. We followed a step-by-step, phased launch approach established by our insurance provider and Reformulary Group that made for a trouble-free transition. Communication to members was personalized, thorough and easy to understand.”



Trillium Health Partners creating a “new kind of healthcare”, which includes the Reformulary !Trillium Health Partners is a leading hospital in Canada with an outstanding record of performance, fiscal responsibility, and quality patient care. The hospital encompasses the Credit Valley Hospital, Mississauga Hospital, and Queensway Health Centre. Trillium Health Partners has set out a vision and plan to create a “new kind of healthcare for a healthier community”, with goals to achieve quality, access, and sustainability. !With an organization-wide commitment to quality, access, and sustainability, Trillium Health Partners was looking for ways to achieve greater employee choice and long-term sustainability from its drug plan. After careful consideration, Trillium Health Partners made the decision to implement the Reformulary as a part of the benefits plan for non-unionized staff. Drug plans powered by Reformulary are structured and managed to maximize value and encourage coverage of drug products that are effective, safe and cost efficient. !Karli Farrow, Vice President, Strategy, People, and Corporate Governance explains, “When we sat down and looked closely at the modeling that Reformulary provided, we saw opportunities to provide better value in our drug plan to members. This aligns with our record of fiscal responsibility and providing quality benefits to our staff.” !The first hospital in Canada to implement, Trillium Health Partners successfully implemented the Reformulary on January 1, 2015. Today, these Trillium plan members have access to DrugFinder to become more engaged in their health care decisions by choosing preferred drugs in their plan.



Reformulary Results 2014 !•Smooth implementation !

•9.4% savings, per member per month

!•Engaged employees

Real Estate 150 lives !•Medium sized real estate company !

•Management considered Reformulary over a year ago, BUT... !

•…were concerned about rocking the boat !

•“We did some cost projections on the demographics of our employee base and drug spend. We were concerned about our plan's sustainability — and knew we needed to act quickly”



University 2,700 lives !•University provides negotiated healthcare benefits to unionized faculty and staff, as well as salaried staff !

•University & OPSEU in bargaining in 2014. University looking for ways to achieve greater value, and open to new or improved benefits that are ‘cost-‐manageable’. OPSEU had requests for improved benefits in certain areas !

•Successfully bargaining, and implemented !

•University now tabling with another union

Results To-‐date !•Smooth implementation !

•Participated in town hall meeting with 200 OPSEU members !

•“…both the members in attendance and I found it extremely informative …feedback from members has been for the most part quite position”



National Freight and Courier Service 2,000 lives !•Recent downsizing. Employee survey identified that employees placed little value on the company’s health and dental plans !

•Company determined that plan was not competitive and needed major improvements in order to better engage and provide value to employees !

•Company wanted to align their drug plan with two of the company’s values: ‘People first’ and ‘transparency’

Reformulary Results 2015 !•Smooth implementation !

•Engaged employees


Reformulary Group Inc. 55 York Street | Suite 1400 | Toronto, ON | M5J 1R7

!!

www.reformulary.com

!http://www.reformulary.com/index_en.php?page=drugfinder

http://www.reformulary.com/

http://www.reformulary.com/index_en.php?page=drugfinder

Mark Faiz Chairman

[email protected] !

Vince Principato President

[email protected] !

Yafa Sakkejha GM

[email protected] !

The Beneplan Co-operative 150 Ferrand Drive Suite 500

Toronto Ontario M3C 3E5 1.800.387.1670

beneplan.ca

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Questions?




http://beneplan.ca

beneplan - benefits law & admin workshop - december 1 2015 - mississauga, ontario, canada

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