Prescription Drug Benefit

Coverage for prescription drugs in Flex Plans 1, 2, and 3 is governed by ESI Canada Dynamic Therapeutic Formulary (DTF). The Flex Plan drug coverage is based on a list of drugs that are reimbursed at a higher level than other drugs available under the plan. This drug list is called a formulary. Formularies have been used for years by provincial government drug programs and in most Canadian hospitals to manage costs. The DTF includes a list of generic drugs that are clinically effective and affordable drugs used to treat most medical conditions. Where there is a generic drug that is considered interchangeable with the brand name drug, only the cost of the generic will be reimbursed.

To find out if a drug is on the DTF, go online at http://www.manulife.ca/groupbenefits/DTF and talk to your doctor. The DTF is not meant to replace your doctor’s best advice. Ultimately, it is up to the participant to work with their doctor to select a drug that will treat their condition, while also factoring lifestyle and DTF coverage into the treatment plan.

A Drug Plan Option is available for schools that prefer the drug coverage in effect prior to 2008 (and still in use for the Standard Plan). Rates are listed in the Benefit Options section of the rate sheet.

Full Issue: No. 327 - May 22, 2009

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