Supporting an aging workforce: Ontario Drug Benefit (ODB)

When it comes to managing the cost of prescription drugs, it helps to understand how your benefits plan works, the difference between brand-name and generic medications, and what patient assistance programs like RxHelp and InnoviCares can do for you . Brand-Name vs. Generic Medications When a new drug is developed, it’s sold under a brand name and protected by a patent for a number of years. Once the patent expires, other manufacturers can produce a generic version of that same drug. What’s the difference? Active Ingredient: Generics contain the same active ingredient as the brand-name drug. Dosage, Strength, and Form: They must have the same dosage, strength, and form (e.g. tablet, capsule). Effectiveness: Generics are required by Health Canada to work the same way in the body as the brand-name version. Appearance: They may look different (colour, shape), but they’re clinically equivalent. Why are generics cheaper? Generic manufacturers don’t have to repeat the costly research and development phase. As a result, generics are typically 15–25% less expensive than brand-name drugs. Why Your Benefits Plan Uses “Mandatory Generic Substitution” Most group benefit plans today automatically cover the generic version of a medication when one is available. This is called mandatory generic. Why? It helps keep premiums and plan costs lower for both employers and employees. It allows benefit plans to cover more people and more services overall. If you or your doctor prefer a brand-name drug, your plan may still cover it if a medical reason is provided (some conditions apply). Patient Assistance Programs: RxHelp & InnoviCares Even with generic options, some prescriptions remain costly—especially for brand-name medications not fully covered by your plan. That’s where patient assistance programs can help. RxHelp Offers individual savings cards for specific brand-name drugs. Works like a secondary payer at the pharmacy—after your plan pays, RxHelp covers part or all of the remainder. Free to join; sign up online or through your doctor. InnoviCares One universal savings card for many brand-name medications. Works with your benefits plan or provincial coverage. Free and available to all Canadians. Why these programs exist Brand-name manufacturers would rather offer a discount and make a sale than lose it entirely to a generic. These programs help bridge the gap so patients can access brand-name drugs at a lower cost. RxHelp & InnoviCares both cover different medications. Refer to their website to see which medications are covered.

Healthcare expenses can add up quickly, but employees can make informed choices to reduce costs without compromising care. Here are some practical tips:  1. Compare Pharmacy Prices Prescription costs vary significantly between pharmacies. Dispensing fees, for example, range from $4.50 at Costco (mail order available without membership) to $12 or more at other retailers. Shopping around can save money and offer convenience. 2. Choose Generics Generic medications are as effective as brand-name drugs but cost only 15-25% of the price. Ask your pharmacist about generic alternatives. 3. Consider Biosimilars If prescribed a biologic drug, explore biosimilar options. These alternatives cost 30-50% less and are often required under provincial plans, especially for seniors. 4. Utilize Loyalty Programs Pharmacy loyalty programs and discount cards can reduce costs on prescriptions and health products. Look for offers like Shoppers Seniors Days for additional savings. 5. Shop Around for Non-Urgent Services For services not covered by provincial plans, obtain quotes from multiple providers. Provincial programs may offer discounts for certain services, particularly for seniors or low-income earners. 6. Be Cautious with Dental Costs Dental work is expensive, but costs vary by provider. Avoid scams or deals like prepayment for services (e.g., orthodontics), as insurers may only reimburse after the service is completed. Additional Tips: Avoid off-the-shelf orthotics unless custom-made ones are unnecessary. Always consult healthcare professionals to ensure cost-saving measures suit your needs. By being proactive, employees can better manage healthcare costs and maximize their benefits. Let us know if you have questions or need guidance!

For incorporated business owners, a Health Spending Account can be one of the most tax-efficient ways to manage healthcare expenses through the corporation. An HSA is a CRA-approved method of providing medical and dental benefits in a tax-efficient manner. A corporation can write off 100% of the costs related to its HSA, while eligible reimbursements are tax-free to employee. What Is a Health Spending Account? A Health Spending Account is a defined annual amount set aside by a corporation to cover eligible healthcare expenses. These expenses can include: Medical services Dental care Vision care Prescription medications Licensed practitioners and clinics HSAs can function on their own or alongside a traditional benefits plan, allowing businesses to tailor their approach based on their needs. Why Business Owners Use HSAs For incorporated owners, HSAs offer a more structured and efficient way to manage healthcare costs. 1. Tax Efficiency Healthcare expenses can be paid through the corporation, where costs are deductible and reimbursements are tax-free. 2. Predictable Costs The annual limit is set in advance, creating clarity around budgeting and eliminating unexpected premium increases. 3. Flexibility Funds can be used for a wide range of eligible expenses, allowing both owners and employees to prioritize what matters most. 4. Pay Only When Used There are no costs unless claims are submitted, making HSAs efficient for businesses that want to avoid paying for unused coverage. There is an option for a budgeted approach. Who Should Consider an HSA? Health Spending Accounts are best suited for incorporated businesses looking to manage healthcare expenses through the company. To implement an HSA: The business must be incorporated The corporation must have active income The employer is responsible for funding the plan T4 income is generally recommended A Simple Example: Personal vs. Corporate Payment Consider a business owner with a $5,000 medical expense and a 53% marginal tax rate. Paying Personally: Requires over $10,700 in corporate withdrawals More than $5,700 is lost to income tax Using an HSA: Corporation pays the $5,000 expense Approximately $1,075 in admin fees and taxes Total cost: about $6,075 Result: Significant tax savings and improved efficiency in how healthcare costs are funded. Important Planning Considerations CRA Alignment HSAs are structured with defined limits and are reviewed annually, which supports compliance from a tax perspective. For owner-managers, it is important that the benefit is received in the capacity of an employee, not solely as a shareholder. We advise employers to offer the benefit to at least one key employee.  Reasonable Coverage Levels A common guideline is to set annual limits within 10–15% of the income of a comparable employee in the same role. For higher coverage amounts, additional justification from an accountant may be appropriate to ensure the plan reflects fair compensation. Final Thoughts A Health Spending Account offers incorporated business owners a practical way to manage healthcare expenses through the corporation while maintaining flexibility and cost control. When structured properly, it becomes more than just a reimbursement tool. It becomes part of a broader financial strategy—supporting tax efficiency, predictable planning, and better use of corporate dollars.

When an employee is off work due to a workplace injury or illness, the focus is often on their Workplace Safety and Insurance Board (WSIB) claim. But in some cases, recovery takes longer than expected, and WSIB benefits may not last for the full duration of the absence. That is where Long-Term Disability (LTD) coverage can become an important next step. Understanding the connection between WSIB and LTD can help employers and employees avoid delays, missed deadlines, and unnecessary claim complications. When a WSIB Claim May Lead to an LTD Claim A WSIB claim can sometimes transition into an LTD claim when an employee’s recovery period extends beyond the support period provided by WSIB. If the employee is still medically unable to return to work after WSIB benefits end, LTD coverage may be needed to provide continued financial support during recovery. Because of this possibility, it is often wise to consider LTD early, even while the WSIB claim is still active. Why Applying Early Matters One of the most important reasons to apply for LTD early is timing. LTD policies often include deadlines for when a claim must be submitted after the onset of disability. If an employee waits until WSIB benefits have been exhausted before starting the LTD application, they may miss the filing deadline. In that situation, the insurer could deny the claim due to late filing. Submitting an LTD claim early, even as a precaution, helps protect the employee’s access to benefits if their recovery takes longer than anticipated. It also gives employers and employees peace of mind that coverage is in place if the WSIB claim ends before the employee is ready to return to work. An Additional Advantage: Waived Premiums If an employee is approved for LTD, there can be added financial relief beyond income replacement. In many plans, premiums for both Life Insurance and LTD coverage are waived while the employee remains on approved disability. This waiver can reduce financial pressure during an already difficult period and helps employees maintain valuable insurance coverage without added cost. By following these best practices, employers can support employees in securing the benefits they may need for long-term recovery while preventing potential claim denials. Early filing helps both employers and employees avoid common administrative challenges, making the WSIB-to-LTD transition smoother and more reliable.

Stop loss coverage is a critical component of group benefits plans, designed to protect employers from unexpected high-cost claims that could disrupt the sustainability of their plans. If you’ve ever come across the term during benefits discussions or renewals, you’re not alone. It’s a vital feature that ensures benefits plans remain financially viable over the long term. Let’s dive into what stop loss coverage is and why it’s essential. ________________________________________ What is Stop Loss Coverage? Stop loss coverage acts as a safety net for employers. It protects against claims that exceed a predetermined threshold. For example, if the stop loss limit is $10,000, the insurer assumes responsibility for any claim amounts beyond that limit. These excess claims are removed from the employer’s claims experience. ________________________________________ Why is Stop Loss Coverage Necessary? Without stop loss, high-cost claims can destabilize a benefits plan, leading to significant premium increases at renewal and making the plan unsustainable. Examples of high-cost claims include treatments for conditions like cancer, multiple sclerosis, cystic fibrosis or autoimmune diseases, which often involve drugs that can cost hundreds of thousands of dollars annually. There has been a rise in high-cost drug claims over the years, their financial impact can be devastating for employers. Stop loss coverage prevents such claims from derailing the stability of a benefits plan by capping the financial exposure for employers. ________________________________________ In Summary Stop loss coverage is a vital tool for maintaining the financial health of a benefits plan. By capping the impact of high-cost claims, it provides stability for employers and ensures that benefits remain accessible to employees for years to come. If you’re reviewing or setting up your benefits plan, be sure to discuss stop loss coverage with your group insurance advisor to ensure your plan is both robust and sustainable. It’s a smart investment in the longevity of your employee benefits program.

When employees are prescribed a medication, cost can become a concern — especially if they want or need to stay on a brand-name drug. While many group benefits plans encourage generic substitution, there are still options that may help employees access eligible brand-name medications at a lower out-of-pocket cost. Two programs that can help are RxHelp ONE and innoviCares . Both are designed to support access to qualifying brand-name medications, and both can be valuable tools for employees who want more choice at the pharmacy. RxHelp says its program can be used alongside a current benefit plan and provides supplementary financial coverage for eligible brand medications, while innoviCares says it coordinates with existing insurance to help reduce costs for qualifying medications. What is RxHelp and innoviCares? RxHelp ONE is a brand-name prescription savings program that connects Canadian patients to participating pharmaceutical manufacturers’ patient assistance programs. RxHelp describes the card as a way to help patients remain on covered brand-name medications, in some cases at little or no additional cost versus the generic alternative. innoviCares is a free prescription savings card available to Canadians for qualifying original brand medications. The program is funded by participating pharmaceutical manufacturers and is intended to improve affordability and support patient choice. innoviCares says it currently covers 65+ medications . What are these programs for? These programs are meant to help people who have been prescribed an eligible brand-name medication and are looking for ways to reduce the cost difference between the brand and generic version. They can also be helpful for people who prefer to remain on a brand-name medication they know and trust, where an eligible assistance program is available. How do RxHelp and innoviCares work? In general, the employee checks whether their medication is on the program formulary, registers for a free card, and presents the card at a participating pharmacy when filling their prescription. The RxHelp ONE card is free, requires a valid prescription from a physician, and can be used at participating pharmacies in Canada. The card can work with an existing benefits plan. innoviCares is also free and if you already have private insurance, the card can coordinate with that coverage to help provide the lowest cost for a qualifying medication. Is there a large list of covered medications? Yes. Both programs promote broad formularies for eligible brand-name drugs. innoviCares says it covers over 65 original brand medications , with some differences by province. Its website directs users to check coverage by province to confirm whether financial assistance is available for a specific medication. RxHelp also maintains a long list of participating medications through its card registration. What about medically necessary brand-name drugs under a group plan? This is an important point for employees to understand: some group plans may still cover a brand-name drug when it is medically necessary , even if the plan is mandatory generic. In those cases, the insurer may require supporting clinical documentation from the prescribing physician, and the request may need to go through a prior authorization or brand-name drug review process. Why this matters for employees For employees, programs like RxHelp and innoviCares can provide more flexibility when a brand-name medication is preferred, prescribed, or medically necessary. They may help lower out-of-pocket costs on eligible medications, support continuity of treatment, and work alongside existing drug coverage in certain cases.

Life Happens: When to Update your Benefits (and Why Timing Matters)

When it comes to medication, a one-size-fits-all approach rarely works. What works for one person may not work for another, or could even cause side effects. Pharmacogenetic testing offers a solution by making personalized medicine a reality in your employee benefits plan.​ What Is Pharmacogenetic Testing? Pharmacogenetics is the study of how your unique genetic makeup influences your response to medications. By analyzing genetic markers, healthcare providers can predict how you’ll metabolize drugs, helping them choose the right medication and dosage from the start. This personalized care approach replaces the traditional trial-and-error method, leading to faster, more effective treatment plans.​ How Pharmacogenetic Testing Works The process is simple and non-invasive—usually just a cheek swab. A lab analyzes your genetic information and provides a report for your healthcare provider, detailing how your body is likely to respond to specific medications. Because your genetic code doesn’t change, you only need this test once, and the results can guide treatment decisions for years to come.​ Common Uses for Pharmacogenetic Testing Pharmacogenetic testing is especially helpful for managing conditions where finding the right medication quickly is crucial, including: Depression and anxiety ADHD Cardiovascular disease Chronic pain management These applications help reduce medication side effects, improve treatment adherence, and enhance overall health outcomes.​ Privacy and Security of Genetic Data Your genetic data is protected under strict privacy laws such as PIPEDA, HIPAA, and GDPR. Testing providers ensure your information is not linked to personal identifiers and that samples are securely destroyed after analysis.​ Why Pharmacogenetic Testing Matters for Employers and Employees Including pharmacogenetic testing in your employee benefits plan delivers tangible benefits for both individuals and organizations: Faster recovery times and shorter disability claims Reduced medication side effects and improved adherence Increased workplace productivity and long-term cost savings Enhanced employee satisfaction and retention Many insurance carriers now offer pharmacogenetic testing as part of their disability management programs, supporting faster return-to-work outcomes and overall plan stability.​ The Future of Personalized Care Pharmacogenetic testing is transforming healthcare by making treatment more targeted, efficient, and effective. By integrating personalized medicine into your group benefits strategy, you can help employees achieve better health outcomes while supporting your organization’s success.​ For more information on how pharmacogenetic testing can be included in your employee benefits, contact Curry Group Benefit Solutions. We help organizations leverage innovations like personalized medicine to support their workforce and strengthen their benefits offerings.​

In a world where healthcare often focuses on treatment instead of prevention, Medcan stands out as a global leader in proactive health and wellness . With locations in Toronto, Oakville, Collingwood, and Muskoka, Medcan helps individuals, families, and employers take control of their health — not just react to illness. Focused on Health span, Not Just Lifespan Medcan’s mission is to help people live well, for life. Their philosophy centers on health span — the number of years lived in optimal health, free from disease and disability. By combining the latest medical research, technology, and evidence-based care, Medcan aims to prevent chronic conditions like heart disease, diabetes, and cancer before they occur. Comprehensive and Personalized Health Assessments At the heart of Medcan’s approach is its Annual Health Assessment , a detailed, physician-led experience that goes far beyond a standard physical. Clients receive same-day results from advanced screenings, including blood work, imaging, and wellness evaluations, all in one visit. This proactive process helps identify potential risks early and provides a clear road map to better long-term health. Specialized Programs for Every Stage of Life Medcan offers an extensive range of specialized services, including: Genetic screenings for cancer, heart health, and medication effectiveness Women’s and men’s health programs addressing hormone balance, fertility, and vitality Mental health and wellness services , including counselling and therapy Nutrition, fitness, and weight management programs designed for sustainable results Sports therapy and rehabilitation for recovery and performance Each program is supported by multidisciplinary medical professionals who work together to create a personalized care plan. Corporate Wellness and Employee Health Programs Medcan also partners with employers to elevate workplace health through customized corporate wellness programs . These initiatives help companies attract and retain talent, enhance productivity, and support the overall well-being of their teams. By focusing on prevention and education, Medcan helps businesses build healthier, more engaged workplaces. A Leader in Preventive and Proactive Care With over 30 years of expertise, Medcan continues to evolve with advancements in medicine and technology. Their proactive model empowers clients to make informed health decisions — turning checkups into lifelong health strategies. Contact us at Curry Group Benefit Solutions for more information