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Pay Direct Drug Card & Mandatory Generic Substitution (announcement)

Pay direct drug card and mandatory generic substitution

We are pleased to advise you that in order to simplify the drug-reimbursement process for you, effective November 1, 2020, you will have access to a Pay Direct drug card which will enable immediate payment of prescription expenses by your McGill Health Plan. Concurrently, to help keep costs down for all plan members, the prescription reimbursement ceiling will be determined based on the least expensive equivalent, usually the generic, unless the prescribing doctor submits evidence that the brand name is necessary for medical reasons.

Pay-direct drug card

How does it work?

Currently, when filling a prescription for yourself or your eligible dependents, you pay the full cost of your medication up front. If you have provided your coverage information, the pharmacist simultaneously electronically submits your claim to Manulife. Later you receive a deferred payment from Manulife for the eligible expenses.

With Pay Direct, when filling a prescription, your pharmacist will send your claim electronically to Manulife and will be able to let you know immediately if the drug is covered under your plan. You then only pay the remaining portion, normally the co-insurance amount.

What do I need to do?

There is nothing for you to do! You keep the same drug card and number. The change will be programmed by Manulife and will automatically apply when the pharmacist already has your coverage information.

If you don’t already have your drug card, you can download it from the Manulife website or through Manulife’s mobile app (available in Google Play or Apple’s App Store).

What if I’m 65 years and older?

If you are 65 years old or older, you should already be registered with RAMQ and the drugs prescribed will continue to be covered under the RAMQ public prescription drug insurance plan. For drugs not covered by the public plan but on the Manulife/McGill formulary, you will be able to use the Pay Direct drug card. You may be required to provide your drug card information at the pharmacy, if they do not already have it on file.

For more information regarding the Pay Direct drug card, coordination of benefits with your spouse’s plan and cost saving tips, click here.

Mandatory generic substitution

In order to introduce the Pay Direct drug card at no additional cost to plan members or to McGill, the Staff Benefits Advisory Committee, together with the University, have agreed to implement the practice of mandatory generic substitution.

Mandatory generic substitution helps manage plan costs by reimbursing the cost of your prescription drug up to the price of the lowest-priced equivalent medication, which is typically a “generic” drug.

Medical evidence shows that, for both generic and brand name drugs, only 1% of the population experience adverse reactions (ie not tolerated or ineffective). If you are currently prescribed the brand-name drug due to adverse reactions, the mention “no substitution” on your prescription will no longer be sufficient. Your treating physician will need to document this information on the required form and submit it to Manulife for review and approval. If you are in this situation, we encourage you to do so as soon as possible before November 1st, 2020 when the mandatory generic substitution will come into effect.

If the drug you are prescribed is a “brand-name drug,” and there is no alternative or interchangeable drug, the plan will continue to reimburse your prescription based on the cost of the brand-name drug.

Members who simply prefer the brand-name drug may choose to use it and pay the price difference between the generic drug and the brand name drug.

Read more about mandatory generic substitution here.

My Drug plan

With the introduction of the Pay direct drug card, members of the Supplemental Health Plan will also have access to “My Drug plan,” and the “Pharmacy savings search” tool:

My drug plan allows you to verify if your medication is covered by the plan, requires a prior authorization, how much the plan covers and how much you pay. It will inform you how you can reduce what you pay by suggesting a lower-cost alternative.

Pharmacy savings search tool allows you to search which pharmacy near you offers the best price for your medication.

My drug plan is easy to use and can be accessed by logging into the Manulife Plan Member Secure Site using your computer, tablet or downloading the My drug plan mobile app.

Find out more about My drug plan here

Want to login into your Manulife account now? Here's how to do it.

Questions?

Once you have reviewed the relevant information, if you have questions, please write to hrhr [at] mcgill.ca.

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