Case Studies
Empowering Health Benefits For Electrical Workers
A Robust Health Benefits Plan
The International Brotherhood of Electrical Workers (IBEW) Local 353 is a labour union representing over 10,000 licensed electricians, registered apprentices, communication and line sector workers and retirees across central Ontario.
IBEW 353’s group benefit and pension plans are jointly sponsored and overseen by a joint Board of Trustees (IBEW Local 353 and the Greater Toronto Electrical Contractors Association). The Toronto Electrical Industry Benefit Administration Services Ltd. (TEIBAS), an organization founded in 1990 to exclusively serve Local 353 members, administers the plan on their behalf. Dedicated to improving the lives of its members and their families, IBEW Local 353 has long recognized the importance of a robust health benefits plan for both its active and retired members. With members wage packages funding their health benefits plan, the Trustees have an obligation to the members of the plan to responsibly manage its benefits plan design to strike the right balance between generous coverage and financial sustainability.
FACET Highlights
Of claims submitted for Prior Authorization by members and their families have been turned around within 2 days
Return on investment, allowing for reinvestment into other needs for IBEW Local 353 members
Of claims submitted for Prior Authorization in 2020 required intervention by FACET’s Clinical Team
Immediate savings on
stop-loss premiums paid by the plan with the introduction of FACET, allowing for further reinvestment
“We’re very impressed by Cubic’s level of compassion and caring, customer service, attention to detail, and the range of ways they can provide insight into our plans challenges and opportunities through data analytics. To my mind, the work Cubic is doing is critical to the long-term sustainability of benefit plans everywhere.”
A Significant Shift
Despite representing just 1% of claims, high-cost specialty drugs had grown to being responsible for over one-third of the benefit plan’s drug spending for the first time in 2015.
Through ongoing Plan Performance Analytics from Cubic dating back to 2011, the Board of Trustees and TEIBAS kept a close eye on the escalating impact of high-cost specialty drugs within its drug plan experience. Despite representing just 1% of claims, these therapies had grown to being responsible for over one-third of the benefit plan’s drug spending for the first time in 2015.
In 2017, there was a significant shift in spending from claims for short-term, acute specialty drugs to specialty claims for ongoing, chronic therapies. With over 85% of the plan’s specialty spending now representing drugs used chronically, and cost pressures from these drugs only continuing to increase, the Trustees and the team at TEIBAS recognized something had to be done to help manage this area and protect the plan and its members going forward. On October 1, 2018, the IBEW Local 353 Health & Welfare Fund introduced Cubic’s independent, evidence-based FACET Prior Authorization Program.
Since inception, over 97% of Prior Authorization claims from IBEW Local 353 members and their dependents have been turned around by Cubic’s expert clinical team within two (2) business days.
In 2020 alone, the FACET Program Clinical Team had to actively intervene on 54% of the new Prior Authorization claims received to ensure the most appropriate, evidence-based medications and dosages were implemented for members. This highlights the impact FACET has had in ensuring the right member is receiving the right drug at the right dose and the right time.
The savings generated by these FACET reviews to date have translated into more than 20 times IBEW Local 353’s investment in ensuring optimal specialty drug use for members, allowing for reinvestment into other areas of need within the benefits plan.
Moreover, with the introduction of FACET, the IBEW Local 353 Health & Welfare Fund was also able to immediately drive savings of over 50% on the premiums for the plan’s catastrophic (stop-loss) insurance, again allowing reinvestment into other areas of need.
“We want to ensure that the members of the IBEW Local 353 and their families can access the drug treatments they need, in their time of need. Continually escalating specialty drug costs make this especially challenging.”
“Cubic helps us to ensure that plan members are getting appropriate treatment with proven efficacy, and that the plan is not funding unnecessary or experimental treatment costs. We avoid paying for higher costs drugs when there are lower cost, more effective treatments available so that we can fund those higher cost necessary drugs when needed. This aligns very well with our focus on plan sustainability, and also does right by the plan’s members.”
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