Rx05 Q & A 

Rx05 Questions & Answers

Q1) What is a drug formulary?

A1) A list of prescription medications selected for coverage under a health insurance plan. Drugs may be included on a drug formulary based upon their efficacy, and safety.

Q2) Why implement a drug formulary?

A2) To increase the value we receive from our benefit dollars. The formulary reduces the rate of increase of costs while providing necessary drug coverage for the TMG group.  The 'savings' from the formulary have been invested in paramedical coverage to better use this money.

Q3) What is a generic drug?

A3) A generic drug has the identical pharmacological active ingredients as the brand name drug. The inactive ingredients such as bonding and colouring agents may vary.  Generic drugs meet the same levels of testing, quality standards and standard of care in order for them to be approved by Health Canada as a generic.

Q4) How will the pharmacists know what drug coverage I have?

A4) Pharmacists can connect to the Sun Life database to determine your drug coverage.  The Sun Life files will be updated for January 1, 2006.  TMG will not need a new drug card.  A letter will be available that you can give to your physician/pharmacist describing the Rx05 formulary (download letter here).

Q5) What happens if my doctor writes "No Substitution" on my prescription?

A5) Normally under the drug formulary a generic drug will be substituted, when available, by the pharmacists.  However you can instruct the pharmacists to dispense the brand name drug specified by your doctor.  In this case you will be reimbursed up to the level of the least cost generic drug.

Q6) How are new drugs added to the formulary?

A6) The drug formulary is a package that covers various drugs.  It cannot be altered to suit individual needs.  An independent body, Revue, recommends the addition of drugs to Emergis, the group the manages the formulary.

Q7) What happens if an employee needs a lifestyle drug eg., weight loss, fertility, erectile dysfunction?

A7) They will have to purchase them independently.  We cannot add lifestyle drugs to the formulary.

Q8) Will an adjudication mechanism be used to address the issues of individuals with the drug formulary?

A8) An adjudication mechanism will be available for exceptions / special authorizations and will be administered by Sun Life Assurance Company, our third party medical and dental administrator.