Prescription Drug Benefits

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Prescription Drug Benefits 

Drug plans are one of the main attractions in a benefit package for a plan member and is one of the most highly used benefits by two thirds of plan members. A range of drug plan and drug formularies can be tailored to suit your organization’s needs; allowing you to better manage your prescription drug benefits versus costs while still providing your plan members with coverage they value.

You may choose from plan designs offering a range of coverage, including the following managed drug plan:

Prescription drug plan:  Prescription drugs are a fast-rising cost component of group healthcare claims due to cut-backs in government-sponsored plans, Canada’s aging population and the introduction of new, more expensive drugs. The plans provide coverage for drugs that require a prescription for dispensing or for sale; which includes some life-sustaining drugs which may be available without a prescription; or may include or exclude over-the-counter drugs.

Claims Payment Options:  You can choose the method of claims payment your plan members will use for their drug purchases.

Reimbursement: This is the traditional payment option where plan members pay for their prescriptions at the time of purchase and submit their claims on paper for later reimbursement.

Pay-Direct Drug Card: This system allows for on-the-spot claims processing of prescription drugs at almost any pharmacy in Canada. A plan member presents his or her card to the pharmacist, who submits the claim electronically. The plan member’s eligibility and drug coverage is confirmed and he or she pays only the portion not covered by the plan.

Deferred drug card: This system is similar to on-the-spot processing of prescription drugs submitted electronically by the pharmacist at the point of sale. The plan member pays for his or her prescriptions and is reimbursed by cheque once a dollar-amount or time-period threshold is reached.

Note: Plans and coverage will also vary depending on the carrier used.

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