In our last blog, we shared drug claim trends across Canada. Now it’s time to take a look at what’s happening closer to home here in Saskatchewan. Employers in Saskatchewan need to know how the Sask Health Drug Plan impacts employee benefits. As well, it’s important to understand recent initiatives announced by the government around biosimilar drugs. There is a lot to be aware of as a benefit plan member and a consumer of prescription drugs. As well, as a benefit plan administrator, you need to be able to help employees who have questions.
Read on for some key information about how Sask Health Drug Plan coverage works in Saskatchewan.
1. Sask Health Drug Plan Refresher
The Sask Health Special Support Drug Plan will cover a percentage of the cost of a Saskatchewan resident’s prescription drugs. Sask Health has a specific list of drugs that they will cover. However, Sask residents must qualify for the program based on their annual income.
First, residents must apply for the program. For those that qualify, Sask Health becomes the first payor when a person purchases their prescription medication. And, any coverage from the employee benefits plan will apply to the balance owed after the Sask Health reimbursement.
What’s important to remember is that every insurance carrier handles drug claims differently. Most carriers will want confirmation that employees with a certain amount of drug claims have applied to the Sask Health Special Support program. As such, each carrier will set a threshold, whereby they will suspend drug coverage until the employee has applied for the Sask Health Drug Plan. It does not matter whether the person qualifies for the government plan or not. If they qualify, Sask Health will pay a portion of drug costs, while the benefit plan will cover the remainder. If they do not qualify, then the benefit plan will continue to cover their prescriptions. Keep in mind that every carrier has a different spend threshold for prescription drugs. This threshhold will impact whether an employee’s coverage gets suspended.
2. An Overview of the Seniors’ Drug Plan
In addition to the Sask Health Special Support Drug Plan, the government also offers a Seniors’ Drug Plan for residents of Saskatchewan who are over the age of 65. As with the other program, qualification for this plan is based on a senior’s net income. If they qualify, seniors will pay a maximum of $25 for prescription drugs that are on the Sask Health formulary.
Saskatchewan residents over the age of 65 can apply to this program at any time. If you have an older workforce, it’s helpful to understand the ins and outs of this program. As explained above, carrier coverage works the same here as in the Sask Health Drug Plan. With that in mind, be sure to keep your employees who are over the age of 65 aware on how their prescription drug reimbursement will work in conjuction with the Seniors’ Drug Plan.
3. Biosimilars and Generic Drugs
The government recently announced its Saskatchewan Biosimilars Initiative. As such, if there is a biosimilar version of a biologic drug, then a person must take the biosimilar in order to be reimbursed by the Sask Health Drug Plan. Biosimilars are a safe alternative to biologic drugs. This guide provides a helpful overview and references about how they work.
An important distinction to be aware of is that biosimilars are not the same as generic drugs. However, something people may not know is that the Government of Saskatchewan has directed pharmacies to dispense a generic drug anytime there is an equivalent under the Sask Health Drug Plan. The only exception is if a doctor has specified that no substitution is allowed for a certain prescription.
We often hear that people don’t love generic drugs, but the reality is that it’s a term not many understand. This is a class of drugs that are highly regulated in Canada and are simply an alternative to higher cost brand-name drugs. Generic drugs are regulated to contain the same active medicinal ingredients in the same proportions as the brand name drug.
Are you up to speed on the many different programs and extended benefits offered by Sask Health Drug Plan? If you’re wondering how these programs might impact your own employee benefits plan and carrier coverage, we can help. Reach out to us for an overview and to chat about your plan today.