Ontario’s Trillium Drug Program (TDP) is an annual government program for residents of the province that spend a disproportionately large portion of their income on prescriptions. The program can be used on its own to subsidize or pay for prescription drugs, or in conjunction with a person’s existing employer-provided benefits plan. By paying through the Trillium plan first, then using their employer-sponsored benefits to cover the remaining balance, the employee passes a significant amount of savings back to the business, as the government acts as the first payer.
Small to medium business owners and human resource departments in Ontario have special needs when it comes to health insurance and benefits. As an independent broker or benefits advisor, there are key aspects to the TDP that you will need to understand in order to accurately counsel your clients and their employees and help them save the most money.
Here is what you need to know, as an advisor, about the TDP so you can work with your clients to understand its benefit and how it will help maximize their savings.
1. Prescription Drug Coverage
Over 3,800 quality-assured drug products are covered by the Trillium benefit, in addition to: 450 limited-use products, nutritional products, diabetic testing agents, and 850 drug products that are not listed on the Comparative Drug Index. The TDP offers an income-based plan for high cost drugs and is designed for individuals who spend 3-4% or more after-tax income on prescription drugs. This is a great benefit for employees, especially since approximately 1 out of 10 Canadians cannot afford to take their medications as prescribed.
Every year, the deadline for applying for the Trillium Drug Program is September 30. Application forms can be obtained online, over the phone, or in person at a local pharmacy. Completed applications must be mailed in to the Ministry of Health.
3. Cost Savings for Employers
Benecaid’s trained Customer Care team work directly and confidentially with employees to claim through the province first, so employers save money by having to cover less through their sponsored benefits plan, HSA, or ASO. By assisting clients with the process helps to save business owners time and help build employee morale by maintaining 100% employee confidentiality and privacy, so they really feel like their benefits plan is working well for them.
4. Requirements for Residents
An employee must be a resident of Ontario and possess a valid Ontario Health Insurance (OHIP) card. They can then register for the Trillium Drug Program if they do not qualify for the Ontario Drug Benefit – meaning the individual is under 65 years old and not enrolled in another drug prescription program like Ontario Works.
5. Trillium as a First Payer
Changes proposed for 2017 include a modernization of the drug plan, making Trillium the first payer on drugs that are part of the Ontario drug benefit formulary. This could mean financial improvements for private plans with the hope that employers will not be able to put controls on their plans with methods like hard caps and exclusions for more expensive drugs.
Many business owners and employers aren’t aware of the cost savings they are entitled to through the Trillium Drug Program. By understanding, explaining, and facilitating the use of this program, Advisors have the opportunity to position themselves as an integral part of their employee benefits structure, and an asset to the business’ bottom line. Interested in becoming a Benecaid Advisor? Check out some more resources or contact us today!