Rx05 Summary

Managed Formulary Design - Rx05

Sun Life Financial and Emergis (the pay direct drug card administrator) offer a variety of managed formulary prescription drug plan designs.  The TMG Non-Cash Compensation Task Force recommended that TMG employees and their dependents move to the managed formulary design known as Rx05 effective January 1, 2006.

Rx05 Defined

Rx05 provides us with a base plan design that is very similar to the existing TMG plan design.  Prescription drugs which require a prescription by law and which are covered by our drug formulary as of December 31, 2005 will continue to be covered with some exclusions.  Mandatory generic substitution will be implemented with the formulary and after January 1, 2006 new generic drugs, and selected new brand name drugs will be added to the plan.

Mandatory Generic Drug Substitution

While Ontario already requires generic drug substitution, the drug formulary will require mandatory generic substitution where a generic equivalent exists.  Where the employee does not accept the generic drug, and purchases the brand name drug, the extended health plan will only reimburse the cost of the generic drug.

Generic drugs are clinically identical to the counterpart brand name drug, with the same active ingredients.  There is no difference in the quality, purity, effectiveness or safety between the generic and brand.  Generic drugs usually come to the market once the patent on the brand name drug expires, and as approved by Health Canada.  Generics will be added to the plan formulary as they become available.

Adding New Brand Name Drugs to the Rx05 Plan design after January 1, 2006

Once a new drug is approved by Health Canada, the Emergis pharmacy team, along with an independent review body, evaluates the new drug for its medical and cost efficacy.  Where clinical evidence supports that the new drug is medically beneficial as a first line treatment, that drug will be added to the plan design. New drugs added to the National Formulary will be added to the Rx05 formulary.

What are the primary differences between the current drug formulary and Rx05?

Rx05 is very similar to the current plan design.  Exclusions under Rx05 include Xenical for weight loss, erectile dysfunction, and fertility drugs. Diagnostic equipment (i.e. glucometers) and extension devices (i.e. aerochambers) will be covered effective July 1st, 2007, but will be separated from the Drug Plan requiring the submission of paper claims.

Not sure whether your prescription drug is covered?

If you have any questions about whether a specific drug is covered under the Rx05 drug formulary, please contact Sun Life directly at 1-800-361-6212 or email .