Prescription Drugs

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FAQ


Select a category below:
​Brand Name & Generic Drugs
Drug Card
​Health Spending Account
Mail Order Pharmacy
Per Script Fee
​Perscription Drugs Eligible Under the Plan

Brand Name & Generic Drugs 

Does the plan cover brand-named drugs?
Yes, but with the following exceptions:
  • if no generic drug is approved on the market (coinsurance will be 90%),
  • your physician completes a medical exception form for consideration if a brand name drug is medically necessary; the exception request will be reviewed by Sun Life and a decision will be communicated in writing (coinsurance will be 95%).
Otherwise, only 95% of the equivalent least expensive generic drug will be reimbursed.
 
What are generic drugs?

A generic drug is a copy of a brand name product. Generic drugs contain the same medicinal ingredients as the brand name drug, and are considered bioequivalent to the brand name drug product. There may be many generic versions of the same brand name drug.

Nearly 45% of all prescriptions filled by pharmacies use generic drugs, and some hospitals use generic drugs almost exclusively. Chances are that you have received a generic drug at some time, whether you realize it or not.
 
Are generic drugs safe?
Generic drugs are safe. Like brand-name drugs, they must meet the strict regulations established by Health Canada, and the Food and Drugs Act and Regulations.
 
Why do generic drugs sometimes look different from brand-name drugs?

Every drug has two types of ingredients: active and non-active. Generic drugs and brand-name drugs share the same active ingredients, which must meet strict government regulations.

However, the non-active ingredients may differ, causing generic drugs to look or taste different from brand-name drugs. Be assured that generic drugs work the same as brand-name drugs, regardless of shape, size, colour and taste.

Can I get a generic version for all my prescription drugs?
Not all drugs have a generic version. Many drugs are protected by patents, which have not expired. Until the patent expires, the company, which owns the patent, is the only company who can produce that drug. Once the patent expires other companies can manufacture the generic version of the drug.

How can I find out if my prescription has a generic version?
Physicians are best at choosing which drug is right for you, but they do not always know which drugs are available in a generic version. Your pharmacist is an excellent source for information on which of your prescriptions can be filled with a generic equivalent.

How do I know if the prescription drug prescribed by my physician is a generic version?
Your physician and/or your pharmacist can confirm if the prescribed drug is a generic version or if a generic equivalent exists in the market. You should tell your physician that your plan will only reimburse the generic equivalent unless they complete an exception request on your behalf.

What is the difference between generic and brand name drugs?
The quality standards for brand name drugs and generic drugs are the same. The ingredients, manufacturing processes and facilities for all drugs must meet the federal guidelines for Good Manufacturing Practices. As well, all drug manufacturers must perform a series of tests, both during and after production, to show that every drug batch made meets the requirements for that product.

The generic drug must contain the same amount of medicinal ingredients as the brand name drug. However, non-medicinal ingredients, such as fillers and ingredients that colour the drug, may be different from those of the brand name product. The generic manufacturer must provide studies showing that the different non-medicinal ingredients have not changed the quality, safety or effectiveness of the generic drug.

To prove that their products are safe and effective, generic drug manufacturers must demonstrate that the generic drug performs similarly to the brand name drug.
 
Why are brand name drugs so much more expensive than the generic equivalent?
Brand-name drugs require more time and money for initial research. In addition, many also employ vast consumer-marketing campaigns, which also adds to the cost. These costs are incorporated into the total pricing of the drug sold to the consumer. On the other hand, generic drugs require less time and money for research, costing consumers, on average, 30 to 40 percent less.

Drug Card

How do I obtain a drug card?
The first step in obtaining your Access ID and Password required to access your profile and Pay Direct drug card is to register with Sun Life Member Services:
 
Registration online

Visit www.mysunlife.ca/navcanada and then select the “Register Now” option under the “Sign-in” section. This process requires you to enter key information to verify your identify.

Once you have entered the required information, you will be provided with an Access ID. Keep this number on hand. Your password will then be sent to you by mail at your home address.

Registration by phone
If you prefer, you can contact the Sun Life Financial Customer Care Centre at 1-800-361-6212. You will also be required to provide key information to verify your identity.

You will be provided with an Access ID. Keep this number on hand. Your password will then be sent to you by mail at your home address.

Once you have your access ID and password you can either view your drug card on the Sun Life mobile app or log on to the Sun Life Financial website at www.mysunlife.ca/navcanada.

Once on the site, you will see a “take me to” drop down menu in the centre of the page. Choose and click on “print a drug card”.

An image of the drug card will appear on screen. Simply print as many copies as you require.

How do I print the drug card?
You can visit the Sun Life website at www.mysunlife.ca/navcanada and enter your Access ID and password.

Once on the site, you will see a “take me to” drop down menu in the centre of the page. Select and click on “print a drug card”.

An image of the drug card will appear on screen. Simply print as many copies as you require.

Will I have any out of pocket expenses when I use the Pay Direct drug card?
When you present your Pay Direct drug card to your pharmacist, you will have to pay the following:

  • the $4 per-script fee, if purchase is not at one of the Preferred pharmacies;
  • 5% or 10% coinsurance that applies;
  • any drug amount over and above the price of the least expensive generic equivalent unless exception request has been approved by Sun Life;
  • eligible drug expenses over the annual maximum;
  • any ineligible drug expenses; and/or
  • eligible drug expenses for your dependents, subject to the coordination of benefits rules.
How do I use my Pay Direct drug card if I also have coverage under another plan?

If your pharmacist is aware that there is a secondary plan and he/she is prepared to accommodate you, they will be able to transmit a claim under the secondary plan, indicating what amount was allowed under the primary plan. This may permit 100% reimbursement of the cost of the prescription.

However, in this case both you and your spouse must have coverage with Sun Life (and both must have a drug card) or your spouse must have a drug card with a carrier who uses Telus Health Solutions (formerly known as Emergis) as their Pay Direct provider.

If your spouse’s health care coverage is not with Sun Life and/or does not have Pay Direct with Telus Health Solutions (formerly known as Emergis), you will not be able to use your Pay Direct drug card for those expenses and must submit a paper claim form for the coordination of benefits portion.
 
How do I use the Pay Direct drug card outside Canada?
The Pay Direct drug card can only be used in Canada. If you are outside the country, you must pay for the expenses and submit a paper claim form to Sun Life Financial to obtain reimbursement.

Why won’t the pharmacist accept the Pay Direct drug card for my dependent's drug expenses?
There are a few reasons why the expense would be declined at the pharmacy counter:
  • you do not have family coverage under the NAV CANADA Health Care Plan (you must apply for the family coverage and register your dependents before you can claim drug expenses with your Pay Direct drug card);
  • your dependent is not registered in the system (e.g. positive enrolment process with your NAV Self Serve Account); or
  • your spouse does not have a Pay Direct drug card feature under his/her Health Care Plan or Telus Health Solutions (formerly known as Emergis) is not their Pay Direct Provider.
In cases 2 and 3, you must pay for the expense and submit an Extended Health Care and Health Spending Account claim form to Sun Life Financial.
 
How can I obtain a card with my dependent’s information on it?
The Pay Direct drug card is not personalized for every family member covered under your plan. As the employee card holder, your information is primary and the dependent information is linked to your record.
 
My name does not appear on the Pay Direct drug card. Can I still present it for use or does the named person need to be present?
If you are a registered dependent of the named person on the card, you can use the Pay Direct drug card without the named person being present. You will need to advise the pharmacist of your relationship to the plan member and your date of birth. The pharmacist will confirm that the information matches what is on file with Telus Health Solutions and process accordingly.

Health Spending Account

How do I claim drug expenses under my Health Spending Account?
You can submit electronically, either online or through the Sun Life mobile app, or by paper form. See the Health Spending Account section for specific instructions.

Expenses incurred in the previous calendar year must be processed using a paper claim form.


Mail Order Pharmacy

Can I use a mail-order pharmacy and still get reimbursed?
A mail-order prescription program is available through our mail-order Preferred Pharmacy for all eligible Health Care Plan members living in Canada.
  • Convenient and cost-effective way of purchasing your prescription medications.
  • Ideal for people who take medications on a regular basis.
  • Vitamins, minerals, and all general drugstore products are available for delivery along with your prescriptions.
  • Will deliver your prescriptions right to your door.
  • Part of NAV CANADA’s Preferred Pharmacy network.
How it works:
  • Our mail-order Preferred Pharmacy will bill Sun Life directly for your eligible prescription drug orders.
  • The only out-of-pocket expense for you is:
    • 5% or 10% coinsurance that applies;
    • any drug amount over and above the price of the least expensive generic equivalent unless exception request has been approved by Sun Life;
    • eligible drug expenses over the annual maximum; and/or
    • any ineligible drug or items (such as regular drugstore items) you choose to purchase.

You can claim the unpaid portion of expense claims through your Health Spending Account, or to another plan for coordination of benefits.

For further information about the Preferred Pharmacy Network contact your Management Pay Advisor at 1-877-361-0003 or managementpayroll@navcanada.ca.


Per Script Fee

How does the per script fee of $4.00 affect me?
If your prescription drug expense is not purchased at one of the Preferred Pharmacies, Sun Life Financial calculates the eligible expense you claim by deducting a per script fee of $4.00 for each Drug Identification Number (DIN) indicated on the receipt once the coinsurance has been applied.  
I am trying to stop smoking. Can the plan help?
Yes, but only with smoking cessation aids that require a prescription and are not available over the counter, to a lifetime maximum reimbursable expense of $1,000. 
 
Does the plan cover Viagra?
Yes, the plan covers all erectile dysfunction drugs up to a maximum reimbursable expense of $1,300 for each covered person in any one calendar year.
 
Does the plan cover experimental drugs?

Experimental products or treatments are never eligible unless Sun Life is satisfied that substantial evidence exists, provided through objective clinical testing, of the product’s or treatment’s safety and effectiveness for the purpose and under the conditions of the use recommended.

Certain life-sustaining non-prescription drugs are covered if prescribed by a physician.

Does the plan cover an unlimited supply of therapeutic or maintenance drugs?
Although there is no maximum limit for drugs, you may only claim what can reasonably be used in three months. The plan will only reimburse a maximum 100-day supply at a time.

Does the plan cover supplies for diabetics?
Yes, including hypodermic needles, syringes, and chemical diagnostic aids. But, if you buy an insulin jet-injector, you cannot claim needles and syringes for the next 36 months.

Does the plan cover contraceptives?
Yes, oral and non-oral contraceptives prescribed by a physician and dispensed by a licensed pharmacist.

Are injectable drugs covered?
Yes, including allergy serums administered by injection.

Where can I obtain a list of prescription drugs that require prior approval?
Click on the following link (you will need to enter the contract number: 25298 once the page loads) or contact Sun Life Financial directly at 1-800-361-6212.

How can I claim weight loss drugs?
Charges for prescription weight loss drugs (includes injectable vitamins and dietary supplements prescribed by a physician in conjunction with a weight loss drug program) will be considered an eligible expense only if the covered person is deemed obese as defined by the World Health Organization (WHO). To find out more about the Body Mass Index and the WHO, refer to their website.

A special authorization form for anti-obesity medication must be submitted to Sun Life Financial and approval received before a claim can be processed. Approval remains on file for 12 months at which time a new form must be submitted for approval.

Published on February 01, 2016