Rx05 Summary

 

Rx05 Drug Formulary Design

 

What is a Drug Formulary?

A drug formulary is a listing of drugs and medicines covered under a drug benefits plan.

 

Rx05 is a managed drug formulary that provides eligible employees with a base plan design that is very similar to previous drug plan designs with some differences.  Rx05 provides coverage for drugs that have a Drug Identification Number (DIN) and are prescribed by a doctor or dentist and are obtained from a pharmacist.  McMaster University does not determine which drugs are covered.

 

What are the primary differences between Rx05 and past drug formularies offered through the Extended Health Care plan?

 

Rx05 is very similar to the past plan design.  Exclusions under Rx05 include Xenical for weight loss, erectile dysfunction, and fertility drugs and the chicken pox vaccine. Diagnostic equipment and extension devices continue to be covered but will be separated from the Drug Plan, therefore a paper claim must be submitted for reimbursement to be made.

 

Mandatory Generic Drug Substitution

 

Mandatory generic drug substitution has been in place in Ontario for several years; as such Rx05 is designed to meet the basic requirements set out by the province. 

 

What are Generic Drugs?

As defined by the Ontario Ministry of Health and Long Term Care, ‘generic drugs' are drug products that contain the same medicinal or therapeutic ingredient(s) as the original brand name drug. Generic and brand name products may look or taste different but both contain the same amount of the same active drug(s). There is no difference in the quality, purity, effectiveness or safety between the generic and brand name versions. Generic drugs usually come to the market once the patent on the brand name drug expires, and as approved by Health Canada.

When an employee submits a brand name drug prescription to the pharmacist which has an equivalent generic drug, the pharmacist is required to dispense the generic drug.  In the event that an employee does not accept the generic substitution, they may purchase the brand name drug; however the Extended Health Care plan will only reimburse the employee up to the cost of the generic equivalent.

 

How are new drugs added to the Rx05 Formulary?

 

Once a new drug is approved by Health Canada, 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.

 

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 . You will need the DIN in order for Sun Life to provide a response.