What is it?
Prescription drug insurance provides comprehensive coverage for certain drugs.
How will it benefit my employees?
A simple claims process makes it easy for employees to receive comprehensive drug coverage.
How does it work?
Employees will be covered for certain drugs prescribed by a physician. Erectile dysfunction and optional vaccines are not covered.
Your employees will have online access to a printable, digital drug card that they can present to their pharmacist when they have a prescription filled. There’s no need to complete claim forms.
Employees can search drugs by name or drug identification number (DIN) using the Drug Coverage Search Tool to find out if they’re covered and at what percentage.
- Calendar year deductible: None
- Per prescription deductible: None
- Reimbursement level: 80% (the plan member pays the remaining 20%)
A formulary is a listing of covered drugs. The formulary of drugs covered under Flexbox includes:
- Drugs and drug supplies when prescribed by a person entitled by law to prescribe them, dispensed by a person entitled by law to dispense them, and provided in Canada.
- Drugs including contraceptive drugs and products containing a contraceptive drug, that require a prescription according to: (a) the Food and Drugs Act, Canada (b) provincial legislation in effect where the drug is dispensed.
- Drugs that must be injected, including vitamins, and allergy extracts. Syringes for self-administered injections are also covered.
- Extemporaneous preparations or compounds if one of the ingredients is a covered drug.
- Drugs that do not require a prescription by law if: (a) They are listed in the current Compendium of Pharmaceuticals and Specialties (b) They are categorized as: antimalarials, fibrinolytics, muscle relaxants, nitroglycerin, potassium replacements, single entity fluorides, single entity iron salts, thyroid agents, topical enzymatic debriding agents.
Great-West Life can limit the covered expense for any drug to that of a lower cost interchangeable drug determined in accordance with Great-West Life’s adjudication practices at the time of claim.
Government drug plans
Covered expenses for drugs eligible under any government drug plan are limited to any amounts the employee is required to pay for their own use or their family under the government plan.
No benefits will be paid for:
- Any drug that does not have a drug identification number as defined by the Food and Drugs Act, Canada
- Any single purchase of a drug that would not reasonably be consumed or used within 100 days
- Drugs administered during treatment in an emergency room of a hospital, or as an in-patient in a hospital
- Non-injectable allergy extracts
- Drugs that are considered cosmetic, such as topical minoxidil or sunscreens, whether or not prescribed for a medical reason
- Smoking cessation products
- Preventive immunization vaccines and toxoids
- Drugs used to treat erectile dysfunction
Coordination of benefits with government or other group plans applies.