Prescription Drug Coverage
For many Canadians, prescription drug coverage is one of the most important benefits under their plan. It is also one of the most costly benefits to provide to our members, which means we continually strive to ensure members have access to cost-effective medications. Here, you will find essential information about your prescription drug coverage under the UA Local 67 Benefits Plan.
Drug Plan Provider Information
- Drug Plan Provider: GreenShield
- Policy Number: UAPP
- Drug Plan Maximum: $15,000 maximum every calendar year, combined with Extended Health coverage – per member or per dependent
- Dispensing Fee: Paid by the member (not covered by the plan). Members can use their Health Care Spending Accounts to cover the cost of dispensing fees.
- Ontario Drug Benefit (ODB) Co-Pay Deductible: Covered for seniors residing in Ontario.
Covered Prescription Drugs
Prescription Drugs
Eligible if they:
- Are prescribed by a legally qualified medical or dental practitioner.
- Legally require a prescription and have a Drug Identification Number (DIN).
- Are approved under GreenShield’s drug review process.
- Are paid on a Pay Direct basis or by the member.
Oral Smoking Cessation Treatment
- Includes medications such as Zyban® and Champix®, where a prescription is required. Limited to 168 tablets per participant, per calendar year.
Drug Supplies and Vaccines
- Drug Supplies: If approved by GreenShield, includes supplies such as diabetic syringes, needles, and testing agents.
- Vaccines: Covered under the plan.
Note: See Medical Supplies and Devices for information about continuous glucose monitors and supplies.
Drugs Not Covered
Drugs for the treatment of obesity, infertility, nicotine replacement products (such as patches, gum, lozenges, and inhalers), reference biologic drugs that have an approved biosimilar, and over-the-counter drugs (whether prescribed or not) are not covered.
Erectile dysfunction drugs are not generally covered, but may be eligible under certain medical circumstances if you have a contributing condition, disease or medication. Have your doctor complete GreenShield’s prior approval form.
Drug Reimbursement Levels
Non-Maintenance Drugs:
- Drugs on Provincial Formulary: 100% reimbursement
- Drugs not on Provincial Formulary: 80% reimbursement
Maintenance Drugs:
- Drugs on Provincial Formulary if purchased through TELUS Health Virtual Pharmacy: 100% reimbursement
- Drugs on Provincial Formulary if purchased at a local pharmacy: 80% reimbursement
- Drugs not on Provincial Formulary: 80% reimbursement
Only the eligible drug cost is covered by the UA Local 67 Benefits Plan; members are responsible for the pharmacy’s dispensing fee. Members can also use their Health Care Spending Accounts to cover the cost of dispensing fees.
Pharmacy Dispensing Fees: Remember to Shop Around
You are responsible for paying the dispensing fee for your prescriptions – the cost for the pharmacist to fill your prescription, which can vary between pharmacies. Learn what your pharmacy changes, and consider comparing it to other places nearby. You can use your Health Care Spending Account to cover the costs of dispensing fees.
TELUS Health Virtual Pharmacy
TELUS Health Virtual Pharmacy is a reliable Canadian online pharmacy offering pharmacy consultations and medication delivery, and is the UA Local 67 Benefits Plan’s preferred provider network (PPN) for maintenance drugs (medications that you take regularly). While you can choose any pharmacy to fill your prescription, as an online pharmacy, TELUS Health Virtual Pharmacy can offer lower markups on prescription drug ingredients. The Welfare Plan passes on these savings to members by reimbursing maintenance drugs on the Provincial Formulary at 100% if purchased through TELUS Health Virtual Pharmacy, compared to 80% if purchased at another pharmacy. In addition, plan members will pay a lower-than-average dispensing fee when using TELUS Health Virtual Pharmacy. How to Use TELUS Health Virtual Pharmacy:
- Register at teluspharmacy.com or call 1-877-796-7979.
- Request prescriptions online or via phone.
- Delivery options include home delivery or local post office pickup.
Important Things to Know
Mandatory Generic Drug Substitution
Where a generic equivalent drug exists, reimbursement will only be made up to the cost of the lowest priced equivalent drug. If a brand name drug is medically required due to a serious medical reaction to at least two generic equivalent drugs, your medical provider will need to provide evidence to GreenShield to determine if the cost of the brand name drug will be covered.
Prior Approval
Certain specialty and high-cost prescriptions require GreenShield’s prior approval before they can be covered by the UA Local 67 Benefits Plan.
Prescription Supply Limits
Generally, you cannot purchase more than a three-month supply of a prescription at one time. Your pharmacist may be able to help arrange a special exception (such as when going on a lengthy vacation) or with prior approval from GreenShield.
Resources for Your Prescription Drugs
To help you manage your prescription drug costs effectively, there are valuable resources available to help you access the medications you need at a lower cost.
innoviCares Card
The innoviCares card is a free prescription savings card available to all members of the UA Local 67 Benefits Plan. It helps save on select original brand-name drugs. Present your innoviCares card at your pharmacy when requesting a brand-name medication.
Trillium Drug Program
The Trillium Drug Program is intended to help Ontario residents who have high prescription drug costs in relation to their net household income. If you or your family member have a high out-of-pocket costs for your prescriptions, you can combine benefits from your UA Local 67 Benefits Plan to cover up to 100% of the cost. When a UA Local 67 Benefits Plan member approaches the $15,000 plan maximum, GreenShield automatically mails out a confidential letter advising of the Trillium Drug Program. UA Local 67 Benefits is available to assist with a Trillium Drug Program application, upon your request. Please visit Trillium Drug Program for more information.
ODB (Ontario Drug Benefits) For Members Over the Age of 65
The Ontario Drug Benefit (ODB) program is specifically designed for seniors, automatically starting when individuals turn 65 years old. This program provides financial assistance to help cover the cost of prescription medications that are on the ODB Formulary, ensuring that seniors have access to necessary drugs without facing significant out-of-pocket expenses.
For eligible members over the age of 65, the UA Local 67 Benefits Plan will pay 100% of the ODB deductible, except the dispensing fees (which are paid by the member and can be claimed under the Health Care Spending Account).
Learn more about how ODB and your UA Local 67 Benefits Plan coordinate.
Have Any Questions?
If you have any questions about your coverage, refer to your Benefits Booklet, or if you need assistance, our team is here to help.