As discussed in our article back in February, Ontario’s Trillium Drug Program (TDP) aimed to make several beneficial changes to their program by September of 2017. These changes however have been postponed.
What were the changes going to be?
The initial announcement by the provincial government was informal and focused on the modernization of the program. Those originally speculating about the improvements hoped that there would be TDP coordination of benefits with private drug plans. The changes were supposed to benefit private plans financially, and the hope was that they would prevent employers from limiting their plans with exclusions for the most costly drugs and hard caps.
On the other hand, the plan itself was not scheduled to change. According to a statement released to Benefits Canada, the changes would indeed have “[enabled] the automatic coordination of benefits between Trillium and private insurance providers.”
Private plans would benefit from this automated coordination, but because the overall format of the program wouldn’t be altered, there would still be the standard of using out-of-pocket expenses to determine eligibility for benefits. Other provinces don’t look at who pays when they determine eligibility for similar programs, and this would benefit Trillium as well.
Why the push back?
It is unknown exactly why we are still waiting on these program changes and why they were pushed back. The statement released to Benefits Canada did not indicate the reasoning or provide further information on timing. It is, however, most likely that the government is making sure that they are organized and able to deliver fully on their promises, as preliminary inquiries showed that the program’s integration with private health coverage as first payer may be more complicated than originally forecasted.
About Ontario’s Trillium Drug Program
The Trillium Drug Program or TDP is a government program that helps out Ontario residents who typically spend 3 – 4% or more of their after-tax income on prescription drugs. The program has the potential to do great things for residents of the province. Furthermore, when used as the first payer for the purchase of prescription meds, it can also mean significant savings for employers. But until the changes discussed above are made, coordination is still complicated.
What does this mean for Advisors?
For now, we’re still waiting on these changes and can only keep following their progress. But in the meantime, for independent brokers, our key understanding of the Trillium program and similar programs in other provinces is that leveraging these programs first when filing claims for prescription drugs will help offset the cost to private plan providers. Properly leveraging these provincial plans for your clients and their plan members is vital for the longevity and the sustainability of their own private plans, too.
Our expertise integrating Benecaid plans seamlessly with the Trillium Dug Program (and other provincial programs) is extensive, and we continue to provide ongoing cost savings for our clients and unique value adds for our Advisors through our many programs and educational material. Email us at firstname.lastname@example.org to learn more.