Prescription Drugs

The Health Association Health plan covers drugs that require a written prescription, have a drug identification number and are on the Manulife Managed Formulary (list of eligible drugs).

 

Coverage Summary

100% coverage of eligible prescription drug expenses to age 70 for active employees and age 65 for retirees.


The Managed Drug Formulary

This formulary is carefully designed to help reduce and control the cost of the plan while still providing you the best possible care. Each drug is assessed to ensure it is proven effective, medically necessary and affordable with respect to its outcomes before it is added to the formulary.  The formulary is updated regularly and is subject to change without notice. For the most up-to-date information about the drugs covered under the plan, you can contact the Manulife Customer Service Centre toll free at 1-855-626-4267. 

An electronic drug look-up tool, “My drug plan” is available through the Manulife Plan Member Secure Website.  Whether you’re with your doctor, at the pharmacy or a home, you can access by computer, tablet or mobile device.  My drug plan answers questions like: Is my prescription covered?  How much does my plan pay?  How much do I pay?  Is there a lower cost alternative?  Does it need special authorization?  It also includes resources like a drug library and provincial drug program information, plus easy access to Manulife’s drug prior authorization forms.  You must be registered on the Manulife plan member site www.manulife.ca/planmember to access the drug look-up tool.

The Manulife Managed Formulary has three key features:

Defined drug list – The formulary is a made up of a list of clinically-effective and affordable prescription drugs that are used to treat most medical conditions.  For drugs that are not covered by your plan, a suitable alternative can usually be found within the formulary that offer similar, equally-effective medical results and is available at a lower cost.  Please check out the Manulife Managed Formulary Ineligible drugs and covered alternatives for more information.

Prior authorization – With some medications, you may need to provide additional information to Manulife in order to determine if the drug is eligible for coverage.  Prior authorization helps to ensure that certain medications are being prescribed for a medical condition or use that is approved by Health Canada and covered under your plan.  Some higher-cost drugs may also require that you try a less costly alternative first.  This helps you get the care that you need at an affordable price.  Please check out the Manulife Managed Formulary, Prior authorization list for more information.

Lowest-cost alternatives – to help manage costs, your plan pays up to the cost of the lowest-priced alternative (typically a generic).  Many brand name drugs have generic equivalents that are considered interchangeable.  Generic drugs have the same active ingredients so they are equally safe and effective as brand name drug, but they generally cost less.


Mandatory Drug Substitution

Making wise choices about utilizing generic drugs when available can save you and your benefits plan money, ensuring your health plan remains sustainable for the future. This means your plan will reimburse up to the cost of the generic drug even if a brand name medication is dispensed. If your healthcare professional has prescribed a medication and indicated “no substitution” on your prescription, your pharmacist may contact them on your behalf in order to confirm that the generic medication can be dispensed instead. For those instances when your healthcare professional indicates there is a medically substantive need to remain on the brand name medication, please contact the Manulife Customer Service Centre toll free at 1-855-626-4267.


Step Therapy

When it comes to your health and the health of your family, you look for prescription medications that work. What most Canadians don’t realize is that for many conditions there are a number of equally safe and effective treatment options from which to choose – and the prices vary.

Step Therapy makes it easier for you to get proven, safe and effective treatments for common conditions that require medication regularly – in a way that can save you money, and help out your drug plan at the same time.

The Step Therapy program applies to people who have one or more of the following common conditions and need to take medication regularly:

  • Gastrointestinal disorders (such as acid reflux and ulcers);
  • High blood pressure;
  • Diabetes;
  • Gout; and
  • High cholesterol

With Step Therapy, the medications used to treat these conditions are organized into a series of steps.  This is automatically done at the pharmacy and consultation by the pharmacist with your physician as necessary.

For full details read the Step Therapy brochure.

 

Drug Maximums

  • Fertility drugs - $15,000 per lifetime
  • Anti-smoking drugs - $500 every 24 consecutive months (including Natural Health Products licensed for sale in Canada by Health Canada)
  • Anti-obesity drugs - $1,000 per calendar year
  • Drugs used in the treatment of a sexual dysfunction - $1,200 per calendar year
  • Preventive Vaccines (including Gardasil) - $500 per lifetime
  • Antihistamine, allergy serum, non-diagnostic antigen Drugs - $1,000 per calendar year
  • All other covered drug expenses – unlimited.
  • *Charges for the following expenses are not covered:
  • The administration of injectable drugs
  • Drugs, biologicals and related preparations which are intended to be administered in hospital on an in-patient or out-patient basis and are not intended for a patient’s use at home.

 

Dispensing Fees

When a pharmacy fills your prescription, it charges you a dispensing fee in addition to the cost of the medication itself. The dispensing fee helps the pharmacy cover the cost of: 

  • Patient counselling 
  • Monitoring drug therapy 
  • Drug information to physicians 
  • Dispensing drug products 
  • Stocking medication 
  • Maintaining patient medication records, and 
  • General operating costs such as employee salaries, rent, taxes, insurance, etc. 

Under the Health and Prescription Drug plan, you are responsible for paying for the cost of the dispensing fee. 

The dispensing fee charged can vary from pharmacy to pharmacy. If you wish to save money on your dispensing fee charges, consider: 

  • Contacting four or five pharmacies to find out their dispensing fees. There can be up to a 40% difference between pharmacies. 
  • Asking your local pharmacist if he or she would be willing to lower the fee for you. 
  • Having up to three-months' worth of your maintenance medication dispensed at one time. 
  • Health Association Nova Scotia has two preferred pharmacy provider arrangements: 
  • MHCSI/Lawtons & Sobeys 
  • Loblaws (Superstore) 

Please check out the following Preferred Pharmacy Provider Arrangement link for further information.
  
Pharmacy arrangements do not preclude plan members from using other providers and Health Association Nova Scotia recognizes that many people have a strong relationship with their local pharmacist.  Our aim is to use our economy of scale to provide plan members with added value and cost savings.