Introducing the New Pay-Direct Drug Card
Beginning January 1, 2014, all members of the PCC Health and Group Benefits Plan will receive a Pay-Direct Drug Card.
The Pay-Direct Drug Card is a fast and easy way to cover your eligible prescription drugs. There are no claim forms to complete and you no longer need to wait for cheques in the mail. All you do is present your card at the pharmacy and your pharmacist will send your claim electronically to Sun Life. Sun Life Financial pays the covered amount directly to your pharmacy so you only have to pay the balance, if any. For claims incurred prior to January 1, 2014, please complete a claim form and submit it along with your drug receipts to Sun Life for reimbursement.
- Your official Pay-Direct Drug Card will be mailed to your home address the week of December 9th.
- Read the “An Easy Way to Claim” document, which provides additional information regarding your new Pay-Direct Drug Card.
Tips to ensure your drug card works well for you and your family:
- Always carry your card with you and present it to your pharmacist.
- The first time you fill a prescription on or after January 1, 2014, please present your pharmacist with your new drug card showing our policy number 50380 and your personal ID # that is listed on the card.
- It is important that the birth date and spelling of names for you and your dependents are correct at your pharmacy. This information acts like a PIN number, linking all information together to process your claim – so if a date is incorrect, it could result in a claim being denied. If there are any changes to those eligible under your benefits plan, please let your pharmacist know.
- If you have family coverage, it’s important to notify the Pension and Benefits Board office about life event changes, such as, marriage, a new child or any changes to your dependents’ information. Remember to include dependent children attending a post-secondary school who still need to be covered.
If your spouse has a benefit plan with a drug card:
If your spouse also has a benefit plan that includes a Pay-Direct Drug card, each of you must submit claims to your own plan first. Unpaid amounts can then be submitted to the other person’s plan. (This is called coordination of benefits.) Your pharmacist can assist you.
To get more information on your Pay-Direct Drug Card or other eligible plan benefits, email the Pension and Benefits Board office or call 416-441-111 or 1-800-619-7301. You can also visit the Sun Life website.
Questions and Answers
Q: What benefit changes are included with the new Pay-Direct Drug Card?
A: As we communicated to you in the Fall 2013 issue of the Windows newsletter, there are two important changes to your drug coverage included with the new Pay-Direct Drug Card:
1. Dispensing Fee Cap
The Pay Direct Drug Card will pay a maximum pharmacy dispensing fee of $9.00 per prescription. This means that Sun Life will pay up to $9.00 of the dispensing fee directly to the pharmacist and you will pay any amount over $9.00.
2. Mandatory Generic Drug Substitution
The Pay Direct Drug Card will only pay the cost of generic prescription drugs. This means that if your prescription is for a brand name drug, SunLife will pay the pharmacist the cost of a generic drug equivalent and you will need to pay the difference between the cost of the generic drug and the cost of the brand name drug.
Q: What if my doctor does not recommend a generic substitution? Is there an exception process?
A: There may be a valid medical reason for not substituting a brand name drug with a generic or lowest priced equivalent drug. Your doctor will need to complete the Drug Exception Application form and provide the medical reasons for the request. If the reasons are accepted by Sun Life, the plan will cover the cost of the brand name drug. Once accepted, Sun Life may request that you re-submit the exception form in the future.
Q: Where do I get a Drug Exception Application form?
A: The Drug Exception Application form is available from Sun Life. Please call the Customer Care Centre at 1-800-361-6212. You may also go online www.mysunlife.ca, sign in using your Access ID and password, and download a form.
Q: How will I know if I am taking a brand name drug that will be substituted for a generic drug?
A: Many pharmacists automatically dispense the lowest-priced equivalent drug and many members may already be getting a generic drug. If you are unsure as to whether you are taking a brand drug, you can speak with your pharmacist.
Q: What if the medication I am prescribed doesn’t have a generic substitution?
A: Most prescription medications have a generic substitution. If the brand name drug you were prescribed does not have a generic substitution, Sun Life will pay for the brand name drug.
Q: Will families receive two Pay-Direct Drug Cards?
A: Yes, if you have family coverage, you will initially receive two Pay-Direct Drug Cards – one for you and one for our spouse. If you need another card, for example, for a student dependent, you can also download and print a paper drug card from the Sun Life website.