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Pharmacy Benefit Patient Assistance

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Many drug plan sponsors in Canada are more commonly changing their drug formularies to mandatory (always) generic substitution. This is in an effort to protect their plans against significant rising drug costs as well as to take advantage of the provincial drug reform that has lowered generic drug pricing to 18-25% of the price of brand name drugs.

These plans allow for exceptions to be made to cover the full cost of the name brand drug if there is a medical reason that prevents a patient from being prescribed the lower cost generic alternative. Many patients, however, do not have a medical reason for wishing to continue to be prescribed the name brand drug; they simply wish to continue to take the drug they have been taking and have come to trust. When a plan has mandatory (always) generic substitution, if a patient wishes to fill the name brand drug, the plan will not reject the claim, but the difference in cost between the name brand drug and its generic equivalent, will not be covered by the plan. This means the patient would be responsible for this difference in cost.

Pharmaceutical companies have developed patient assistance programs (PAPs) for a long list of brand name drugs and offer coverage for the difference in price. This allows the plan to continue to benefit from lower cost alternative drugs while the patient can remain on the brand name medication they’d like, at little to no additional cost to the Member. The technology resembles that of the drug card. These programs are RxHelp ONE™ and innoviCares™. Part of the registration process is to identify which drugs are covered by the PAP.

Once registered, simply fill the prescription using your drug card, present the applicable PAP card, requesting that the name brand drug be filled, and the PAP card will cover the balance of the cost between the applicable name brand and the generic. Not all name brand drugs are eligible under a PAP. The list of drugs they do cover are found on their websites.

These types of programs are most useful to patients where their benefit plan requires mandatory generic substitution.

Health Benefits

Health Benefits

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Protection against financial hardship that often accompanies sickness, accident or death is important to all of us. Your Plan is intended to bring greater peace of mind and an increased feeling of security to you and your family.

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Pension Plans

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