Solutions to manage drug plan costs
At iA Financial Group (Industrial Alliance Insurance and Financial Services Inc.), we are committed to supporting the sustainability of our clients’ drug plans. In order to continue offering you services that meets your expectations, we are happy to outline two of our solutions to manage drug costs.
1- DRUG EVALUATION
We are constantly monitoring new drugs coming to market to be able to promptly identify certain cases that may affect the financial health of our group plans. Before authorizing the coverage of these new drugs, we put them through a thorough evaluation process to assess the financial risk they represent to the overall health of our plans. A team of experts assembled by iA Financial Group then reviews the results and determines if the drugs will be covered, covered with prior authorization or, in certain cases, not covered.
A list of prescription drugs requiring prior authorization is kept updated on our website at ia.ca. Also, plan members can consult WebRx®, our online drug tool available through our secure platforms My Client Space and iA Mobile to see if special coverage indications are in effect for a prescription drug. More information regarding non-coverage of a drug will be published in our quarterly Infobulletins. Please note that, if applicable and under certain circumstances, you may still be able to add coverage to your plan for prescription drugs not covered by iA Financial Group with a plan pricing adjustment.
2- EXPRESS SCRIPTS CANADA PHARMACY, A PROVIDER OF CHOICE FOR DRUG MANAGEMENT
With our goal to keep drug plan costs at a reasonable level, we partnered with the Express Scripts Canada Pharmacy. This pharmacy offers competitive pricing on prescription drugs, which will allow you, as well as plan members, to achieve significant savings.
As of now, the eligible reimbursement amount for specific prescription drugs requiring prior authorization will be based on the price available at the Express Scripts Canada Pharmacy. The first targeted drugs will be those that treat certain chronic inflammatory conditions and Hepatitis C. They will be clearly identified in our list of drugs requiring prior authorization available on our website. Plan members who complete a prior authorization request for an identified prescription drug will receive a written notice from iA Financial Group inviting them to fill their prescription with our preferred provider and containing all the necessary information to communicate with the Pharmacy. This applies to plan members across Canada, except in the province of Quebec.
Plan members will still be able to fill their prescription at another pharmacy. However, the reimbursement will be made based on our preferred provider’s price. Any excess amounts, if applicable, will be at the plan member’s expense. As for already authorized drugs for which a treatment is ongoing, a notice will be sent upon renewal of the authorization.
In order to allow you to take advantage of the many benefits offered by the Express Scripts Canada Pharmacy, we continue to design new solutions adapted to the reality of today’s market that will meet your needs.
CLARIFICATIONS TO CONTRACTS
To better reflect our administrative practices explained in this communiqué, below you will find the clarified contractual wording that is currently included in all new standard contracts and that will be updated in all existing group insurance contracts and administrative services only (ASO) agreements as of June 1, 2016, either when the booklets are reprinted or when the contract is amended (whichever comes first):
Group Insurance Contracts
Certain drugs will require pre-authorization by the insurer prior to the commencement of their usage. For these drugs the insured person will be required to have his attending physician provide the insurer with information describing his medical condition, previous treatment history and the medical criteria for prescribing the drug.
As part of its pre-authorization process, the insurer may request that a drug be purchased from a preferred pharmacy network that has been approved by the insurer. If the insured person should choose to use another pharmacy, the amount reimbursed to the insured person will be based on the amount which would have been charged by the insurer’s approved pharmacy network. The insurer will not be responsible for any amounts in excess of the amounts that would have been reimbursed had the insured person used the approved pharmacy network.
The insurer reserves the right to exclude coverage of any drug where it has determined, at its sole discretion, that coverage of the drug causes or may cause a material change in the risk insured under this policy or a material change in risk for the insurer in general.
For any drugs which are excluded from coverage by the insurer under the Dispensing Limitations provision of this benefit.
Administrative Services Only Agreements
Certain drugs will require pre-authorization by the Administrator prior to the commencement of their usage. For these drugs the Covered Person will be required to have his attending Physician provide the Administrator with information describing his medical condition, previous treatment history and the medical criteria for prescribing the drug.
As part of its pre-authorization process, the Administrator may request that a drug be purchased from a preferred pharmacy network that has been approved by the Administrator. If the Covered Person should choose to use another pharmacy, the amount reimbursed to the Covered Person will be based on the amount which would have been charged by the Administrator’s approved pharmacy network. The Covered Person is solely responsible for any amounts in excess of the amounts that would have been reimbursed had the Covered Person used the approved pharmacy network.
The Administrator reserves the right, at its sole discretion, to exclude coverage of any drug where coverage of the drug causes or may cause a material change in the Company’s costs of the benefits under the Plan or a material change under any Pooling Insurance Agreement in place between the Company and Industrial Alliance Insurance and Financial Services Inc.
For any drugs which are excluded from coverage by the Administrator under the Dispensing Limitations provision of this benefit.
If you have any questions or concerns regarding this communiqué, please contact your benefits advisor or your iA Financial Group account executive.