There are 3 types of Prescription Drug reimbursement programs:
- Reimbursement for Brand Name Drugs with no option for Generic Drugs. This means that if there is a generic drug available the insured does not have to elect this option. The plan will pay for all Brand Name Drugs. Telus Health has indicated that there is still 27% of plans that have this option available to their insured’s.
- The second option is when a Generic Drug is available the plan will pay for this option. If an insured and their Doctor do not feel this is the best option for them they write “No Substitution” on the prescription and the Brand Name is covered by the Insurance Company. Approximately 37% of benefit plans operate under this option.
- Mandatory Generic also known as “Always Generic” has been increasing in popularity over the years. Generic substitution rider has increased from 19% to 36% over the last year and this comes from groups who were previously using generic substitution and now want to ensure their savings are maximized.
Empire Life has provided a brochure that explains how Mandatory Generic Substitution works. In a very small number of cases, an employee may have an adverse reaction to a generic drug. If this happens, the employee should go back to the doctor and get a prescription for a different generic. If there is an adverse reaction to the second generic, the doctor can prescribe a brand name drug; however, in order for the cost of the brand name drug to be covered, the doctor must complete a “Request for Drug Substitution” form for the employee to send to us for review. While this is being sorted out, the employee will continue to be covered for the cost of the generic drug.
To better understand your benefit plan, please contact Glendinning Insurance Services.