Benefit Legislations

OHIP Children & Youth Pharmacare

Starting January 1, 2018, Ontario residents of age 24 years and under are eligible to receive certain prescription medications for free with their health card number and a valid prescription. Medications currently on the Ontario Drug Benefit (ODB) Formulary and eligible Exceptional Access Drugs are part of this new government program, OHIP+.

Pension Plan Changes

IMPORTANT: This email is for your information and action.
Effective January 1, 2016, pension plan administrators are required to file statements of investment policies and procedures (SIPP), for all registered pension plans, with the Financial Services Commission of Ontario (FSCO).
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Impact of the Ontario Registered Pension Plan (ORPP)

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Ontario Dental Fee Schedule

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Ontario’s really bad pension scheme

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Canada Pension Plan Amendments – May 2012

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Ontario government proposes drug system changes to benefit all Ontarians 10-08

The Ontario government has proposed changes to its drug system that will bring greater equality in generic drug pricing to public and private payers on a phased-in basis. These changes should benefit all Ontario residents.

Changes proposed for May 15, 2010

Generic drug pricing will be regulated for both the public plan (Ontario Drug Benefit program) and the private market (group benefit plans and cash-paying customers). Regulations regarding professional allowances (fees paid by generic drug manufacturers to pharmacies), dispense fees and pharmacy markups are also changing. A summary is provided in the following table. Public plan – Ontario Drug Benefit (ODB)

Private market Generic drug pricing

• Currently 50% of the brand-name price
• Moves to 25% of the brand-name price effective May 15, 2010
• Currently unregulated
• Moves to:

–  50% of the brand-name price effective May 15, 2010

– 35% on April 1, 2011

– 25% on April 1, 2012

Professional allowances

• Currently 20%
• Reduced to 0% effective May 15, 2010
• Currently unregulated
• Limited to:

–  50% effective May 15, 2010

– 35% as of April 1, 2011

– 25% as of April 1, 2012

– 0% as of April 1, 2013

Dispense fee

• Increases to $8 from $7, effective  May 15, 2010
• Increases an additional 2.5% in each of the next five years, beginning April 1, 2011
• Rural dispense fees increase between $1 and $4, depending on physician access and pharmacy concentration in each area.
• No change (not regulated)

Cap on markup

• Remains at 8%, but will be capped at $125 (cap will affect prescriptions that cost more than $1,500)
• No change (not regulated)
Impact on benefit plans Private plans covering Ontario residents age 65 and older – Currently, these residents are generally covered by the ODB plan, with private plans as the second payer. Private plans cover the ODB out-of-pocket, which means:
• The first $100 of prescription drug costs in each benefit year
• A maximum of $6.11 towards the dispense fee, per prescription, once this deductible has been reached With this structure in mind, the proposed changes will have a moderate impact on private plans and ODB claims. For non-ODB covered drugs, there will be some cost savings on generic drugs. Private coverage for plan members under age 65 – Currently, generic prices range from about 60 per cent to 70 per cent of the brand-name price.
Therefore, the phased-in regulation of prices for all Ontario residents will have a positive impact on costs. Great-West is working to quantify the impact and will provide updates. The rollout of these proposed regulations is being closely monitored by Great-West. The announcements will mean reductions in revenue to pharmacies – both from lower retail prices that are allowed and from smaller professional allowances. One impact to plan members may be a cost attached to home delivery of prescription medication. Some pharmacies have already announced that this previously free service will now be charged to the customer. Our contracts do not cover the costs of home delivery fees. Effect on other provinces Ontario’s changes may result in changes in other provinces as well. Quebec’s “favoured nation” clause may lead to pricing changes in that province, and Newfoundland and Labrador has legislation that ties its pricing to Ontario drug policies. Great-West is working to determine how these provinces may be affected and the timing of any potential pricing changes. Alberta recently announced changes to its generic drug pricing (see GroupLine 10-01 released in February 2010). Other provinces are monitoring these developments and it’s anticipated they may also implement drug pricing changes.

Why Ontario is proposing these changes

According to the Ontario government, these changes are intended to provide better access to lowercost generic drugs for patients while allowing the government to continue to increase annual funding to the drug system as a whole. Among its stated goals are:
• Lowering the cost of generic drugs for all Ontarians
• Ensuring pharmacists are compensated fairly for helping patients by increasing dispense fees and paying for additional services provided to patients
• Supporting access to pharmacy services in rural communities and under-serviced areas with new dedicated funding

Ontario estimates these changes will save the province $500 million. The provincial government says $250 million will be reinvested in the healthcare system, including $100 million for MedsCheck, a program that allows Ontarians to schedule a comprehensive annual review of their medications with a pharmacist. Great-West supports the drug system changes proposed by Ontario and the greater equality they will ultimately bring in drug pricing for all Ontarians. For more information Visit the Ontario Ministry of Health and Long-Term Care website at http://www.health.gov.on.ca, or contact your benefits advisor or Great-West group representative. This GroupLine is for general use and informational purposes only. It is not intended to be legal or tax advice. You should consult your professional advisors about your particular circumstances.

Recent Retirement Legislation

Client Alert:

Phase 2 of Ontario Pension Reform

Further to our August 24th bulletin, Blakes will make submissions to the Ontario Ministry of Finance on a number of Phase 2 proposals. Should you wish us to include your comments or concerns, please speak to any member of our Pension & Employee Benefits Group.

Two additional pieces of information which may be of interest:

1. As noted in our bulletin, the Phase 2 legislation is going to precede the Phase 1 and 2 regulations. We have confirmed with the Ministry the expected order of the regulations, and the Phase 2 regulations will precede the Phase 1 Regulations.

Ontario Regulatory Policy provides that Ontario regulations are only effective January 1st and July 1st. Accordingly, there will likely be a significant time lapse between the Phase 1 pension legislation (Bill 236) and the regulations relating to that legislation.

2. The reference in the August 24, 2010 Technical Backgrounder to protecting surplus rights in plan splits and mergers will only apply on termination of the merged plan. The right to merge pension plans and cross-fund will not be restricted in a merged plan notwithstanding any termination surplus language.

Should you have any questions, please speak to any member of our Pension & Employee Benefits Group.

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