New Drug Formulary for Members of CUPE Local 4951 at the College of New Caledonia
Effective March 1, 2013, the College of New Caledonia and CUPE Local 4951 have negotiated a change to the prescription drug plan that is provided through Manulife Financial Contract Number 83709, such that only drugs listed on British Columbia’s PharmaCare Formulary wil be eligible for reimbursement, unless special authorization is obtained through PharmaCare. It is important that you inform your doctor of this change to your prescription drug plan on your next visit.
Claims incurred prior to March 1, 2013 Prior to March 1, 2013, most* drugs that legally required a written prescription from a Physician or Dentist were eligible for reimbursement. If the claim was submitted electronically through the Pharmacist, reimbursement was limited to the cost of the generic equivalent drug, if one was available. (*There were restrictions on certain types of medications and these were described in the booklet). Claims incurred on or after March 1, 2013 Effective March 1, 2013, only drugs listed on BC’s PharmaCare Formulary are eligible for reimbursement unless you or your eligible dependent obtains Special Authorization through PharmaCare. Impact on you and your family The impact on you, your spouse, and your children, will depend on your current drug usage. Following are a few examples: If you take a medication that is listed on the BC PharmaCare formulary… You wil not be impacted. For example, Crestor is currently on BC’s PharmaCare formulary and you will continue to be eligible for reimbursement under the employer sponsored plan. Once you have reached your annual PharmaCare deductible, PharmaCare will start to share in the cost. If you take a medication that is not is listed on the BC PharmaCare formulary but is eligible for Special Authorization… You will need to speak with your physician about applying for Special Authorization. The Special Authorization program is designed to ensure access to drugs based on patient-specific needs. This means your attending physician will need to provide medical support to PharmaCare for the drug that has been prescribed in order for you to be eligible for reimbursement under BC PharmaCare. If PharmaCare approves the drug, then you will also be eligible for reimbursement under our plan. If PharmaCare does not approve the Special Authorization, then you and your attending physician will have to select a different drug or you will have to pay for the drug yourself (possibly with access to some financial assistance through the drug manufacturer). NOTE: existing exceptions for all prior authorization drugs will be maintained going forward, regardless of whether or not the drug is on the PharmaCare formulary. These are the drugs that require prior approval before coverage is granted even under the existing plans. The reasons for prior approval vary, and generally relate to the need to ensure that the drug is being prescribed in accordance with recognized Canadian medical guidelines and/or that coverage through public plans is being accessed where available and/or that the drug is being used for a
Page 2 medically required purpose and not, for example, for cosmetic reasons. If you have obtained approval in the past, you need only forward a copy of the approval (which is likely on file with your doctor or pharmacist) to Manulife. If you take a medication that is not listed on the BC PharmaCare formulary and is not eligible for Special Authorization… You will need to ask your physician whether an alternate drug could be prescribed. If an alternate drug is not available, you should contact your Staff Representatives, Lily Bachand or Marnee Boman as well as Rachel Jensen in the Human Resources Department.
If you take a medication regularly, you can search the BC PharmaCare website to determine if the drug is eligible. For More information Contact BC PharmaCare directly If you have questions about the BC PharmaCare formulary, you can contact BC PharmaCare directly at 604-683-7151 or toll-free at 1-800-663-7100. Customer service representatives are available Monday to Friday from 8:00 a.m. to 8:00 p.m. (except statutory holidays) and Saturday from 8:00 a.m. to 4:00 p.m. (except statutory holidays). Contact Manulife Financial If you have a question regarding how a claim was adjudicated, contact Manulife Financial toll free at 1-800-575-2200 and select option 1. Customer service representatives are available Monday to Friday from 5:00 a.m. to 5:00 p.m. (except statutory holidays). If you prefer, you can submit your inquiry in a secure and confidential environment by using the send-a-note feature on the Manulife Plan Member Site.
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