OPSEU Drug Benefit Plan

OPSEU prescription drugs are reimbursed using the Pay Direct Drug Card, which eliminates the need to pay up front for prescriptions.

Receiving your drug card

Sun Life Insurance will send your card to your home address shortly after you become eligible for benefits. Please ensure that Human Resources has your correct and current address on file by logging into eHR at my.torontomu.ca. For detailed instructions on updating your address information in eHR, visit the eHR Online Learning Module for Personal Information.

If you don’t receive your drug card before you need to use it to purchase prescription drugs, you can print a paper card from the Sun Life website:

1. Visit www.sunlife.ca (external link)  and select “my Sun Life” under the “Select a Site” drop down menu.
2. Sign in using your access id# and password.
3. Click on “Take Me To” drop down menu and select “Print Drug Card”.

You may also contact Sun Life directly at 1-800-361-6212.

If you have family coverage and you have enrolled your eligible dependents, you will receive two cards but both cards will have your name on it. You can always print additional cards using the instructions indicated above.

For instructions on enrolling family benefits, visit the Eligibility and enrolment information.

Using your drug card

The drug card will only allow pharamacies to charge the agreed upon cost amount for the drug, so be sure to use the drug card for every prescription drug purchase. If you don’t use the card and instead pay cash and submit the receipt to Sun Life for reimbursement, you may not receive the full amount paid.

Pharmacy drug dispensing fee

This is the fee that pharmacies charge to dispense the medication. There is a $9 dispensing fee cap built into the drug card for all prescription drug purchases. If your pharmacy charges more than $9 you are responsible for paying the difference. Some pharamcies will reduce their dispensing fee to keep your business if you ask them.

Sun Life evidence-based drug plan

This plan evaluates drugs based on their effectiveness, cost and use. The drugs are sorted into three tiers, which then determines at what level the drug will be reimbursed.

For all classes of drugs (e.g. cardiovascular, diabetes, etc.) there will always be a drug that is covered at 100% and approximately 80% of the most common prescription drugs are covered at 100%

Tiers and levels of reimbursement

If your drug is not covered at the highest level (Tier 1), you should speak with your doctor about a Tier 1 alternative that is appropriate for you. You may purchase any drug that your doctor recommends for your condition, however, your reimbursement will be limited to the terms outlined above.

If there are valid medical reasons for not substituting a Tier 1 drug such as a severe adverse medical reaction to an alternative drug, your doctor will need to complete the drug exception form and submit it to Sun Life for review. You may contact Sun Life directly to obtain this form.

Generic vs. brand name drugs

A generic drug doesn’t necessarily mean the drug is classified as a Tier 1drug. Generic and brand name drugs are evaluated based on their clinical effectiveness and cost to determine which drugs offer the best value.

Filling prescriptions out-of-province/country

If you are travelling out-of-province and/or out-of-country and if the pharmacy will not accept the pay direct drug card then you can submit claims to Sun Life electronically. You will only be reimbursed up to the limit negotiated by Sun Life. For this reason, you may want to consider having your prescriptions filled before you leave Ontario.

For more information on out-of-province/country coverage, visit Travel emergency medical coverage.

Drug Finder

The Drug Finder is an online tool that will tell you what drugs are covered under the plan, the level of reimbursement and identify possible alternative drugs that could cost you less.

Visit reformulary.com/drugfinder (external link)  and log in using the username RYERSON@Reformulary and password aw2014. The username and passwords are case sensitive.

Questions?

To confirm if a specific service or items is covered, please contact Sun Life Financial at 1-800-361-6212 or visit the Drug Finder website (external link) .

If you have additional questions, please contact HR Pensions and Benefits.