Please see the below message from our K-12 coordinator. I have also recieved a few questions from members regarding the new drug plan. Some of this is repeat information but you may find it of use.
A helpful link to asssist members in finding a pharmacy within the dispensing fee and mark up caps that are part of the new drug plan is in the link below. The FAQ link below that explains further.
Please also see this BlueRx what you need to know pdf
Some questions have been raised about the grand-parenting of certain drugs and prescribed drugs that require prior approval. Accessing the forms people might need to complete has been raised as a concern. Below is some information that might be helpful. I have also attached a document that was sent out some time ago which also may provide some guidance.
There is detailed information on the micro-site that PBC set up for members of support staff unions here: http://www.pac.bluecross.ca/cupek12/faq.aspx This link should take you to the FAQ page – see question #4
Under the BlueRx plan, if a member begins to take a drug that requires approval before it is covered it could fit into one or two categories.
1. Pharmacare Special Authority. If a drug is considered a special authority drug under Pharmacare then the physician must apply for coverage on the member’s behalf. This is a process that physicians are very familiar with and should be doing anyway on the member’s behalf. If they do not the member can request that they do. When the drug is approved the member can get a printed copy of the decision by contacting BC Pharmacare (details on the website noted above) and then submit it to PBC. The drug will then be covered. If a member already has approval then they just need to call to get a copy of the letter for submission to PBC.
2. PBC Prior Approval. There are certain categories of drugs that PBC has identified as requiring approval. In question #4 of the FAQ’s it lists these categories. If you click on a category it will show which drugs in that category require approval. If the drug is not in the list the member should contact PBC to check if it is covered under the plan. That way if it is not covered they can speak to their physician about alternatives, if they wish.
There is a specific form for each category (also available when you click on the category link). The physician completes the form and the member submits it to PBC for approval.
Once a drug is approved the member can use their drug card to purchase the drug. If they paid out-of-pocket previously and now have approval we believe they are able to submit their claim via paper to get it reimbursed.
In addition to going to this website there will be information if a member logs into Caresnet.
Temporary CUPE K-12 Coordinator