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Agent Update - Individual Business

Posted by Medavie Blue Cross on June 29, 2023

Summer Contest

Have you heard the news?

You could WIN a remarkable weekend for 2 at the exclusive Algonquin Resort!

The contest runs from May 15 until August 31, 2023.

If you are looking for ideas and support to help with your WIN, please reach out to your Account Representative.

Expansion of Generic Substitution

We are committed to ensuring our plans direct every dollar spent toward providing your clients with the proper treatment at the right time. This focus helps keep the plan sustainable while integrating emerging drugs and treatments in the plan as needed.

Substituting lower cost generic drugs in place of their more costly equivalents is one of the most effective ways to control drug costs while also ensuring access to care.

Different provincial pharmacy regulators apply a variety of rules around what drugs can be substituted. Some only permit substitution for drugs covered by the provincial formulary while others allow interchangeability for all drugs.

Over the coming months, we will be expanding the coverage of our generic substitution program to include all drugs, where allowed by provincial regulation in New Brunswick (NB), and Prince Edward Island (PEI). Pharmacists will be directed to begin substituting specific medications that are recognized as pharmaceutical equivalents by Health Canada.

Member Experience

If you have clients living in NB or PEI, some members may see a reduction in the reimbursement to the generic equivalent amount of some medications they currently are covered for.

Over the next few months, affected plan members will receive a communication outlining the change and their options, giving them time to prepare for next steps. Members who wish to continue to use the non-generic version of a drug can do so, paying the cost difference between the products.

Options, Options Plus and Select members may have an amendment issued, providing one month’s notice, to reflect a change to the interchangeable drug definition in the policy booklet.

All pharmacies in NB or PEI will also receive a communication outlining the change and how to support member questions.

See the Generic Drug FAQ for additional support.

Adapting Plan Coverage to Reflect Today’s Diabetes Treatments

Over the past two years, the landscape for diabetes has seen substantial developments. Notable trends include:

  • Effective new diabetes treatments called GLP-1 receptor agonist drugs (most notably Ozempic), are increasingly prescribed “off-label” as a treatment for other conditions including obesity
  • A rising number of members claiming diabetes drugs, including GLP-1 receptor agonist drugs
  • Newer treatments for diabetes in developments

In addition to current measures including quantity limits and tier controls, we are introducing the following plan management enhancements to help ensure appropriate care, starting August 1, 2023:

  • Continued access for any members with previously provided coverage for a GLP-1 receptor agonist drug, ensuring that ongoing treatments are not interrupted.
  • Addition of Automated Prior Authorization for any new claims for GLP-1 receptor agonist drugs, requiring that member history shows previous treatment for type 2 diabetes.
  • If validated, the claim is seamlessly approved with applicable copay at the pharmacy counter.

For all plans, there is no impact to current claimants. If a new claimant is ineligible, pharmacists can provide real-time assistance about their choices.

Salesforce Online Application Enhancements – Stand Alone Dental

Stay tuned to find out more about the ways we are enhancing the online application process for our Internal Dental product to align with our other online applications as we share developments in upcoming communications.

Insights Webinars - Recordings Available

If you haven't had the chance to attend our last two Insights Webinars, click the link below to view the recording:

A Topical Discussion on Diabetes and Weight Loss
Drive Your Plans with Data 2023

Happy Canada Day!

We hope that you make the most of this Canada Day and take this opportunity to enjoy some time with your loved ones. Our sincerest thank you for your ongoing support and trust in doing business with Medavie Blue Cross.