Prescription Drugs are covered under the Supplementary Health Care Plan. Coverage is limited to drugs which are available by law only on the written order (prescription) of a Physician or Practitioner and dispensed by a licensed pharmacist. Coverage includes the following:
- 100% of eligible expenses on a Least Cost Alternative (LCA).
- Over the counter medications which are prescribed by a Physician and approved by Sun Life as an accepted treatment for a chronic life threatening disease.
- Vaccines and influenza shots, including the cost of administration of the injection.
- Varicose vein injections where medically necessary, including the cost of the administration of the injection.
- Drugs for the treatment of Erectile Dysfunction will be limited to a maximum of $1200 per Insured per Year.
- Prescribed contraceptive devices such as an IUD or patch, including cost of administration of device.
- Medical marijuana purchased from either Health Canada or a designated producer subject to the Marijuana Medical Access regulations.
- A 3 month supply of prescription drug purchases may be dispensed at one time.
- Medication and dietary supplements which are available over the counter without a prescription are not covered.
The LCA price is the lowest cost medication in an interchangeable drug grouping. Interchangeable drugs are those that are considered bioequivalent through scientific study or have identical amounts of the same active ingredient by dosage and method of administration. This means that a LCA may be a name brand or a generic equivalent.
You will have to decide when purchasing the drug(s) whether to opt for the Least Cost Alternative/Generic Equivalent or pay the difference in price between that prescribed by your physician and the amount covered by the SHC Plan.
Where the substitution of Least Cost Alternative or Generic Equivalent will have a negative impact on the treatment outcome, your physician must indicate "No Substitutions" on the prescription.
We would suggest you discuss these plan restrictions with your physician prior to obtaining your drug prescription(s) in order to avoid any misunderstandings.
Accepted at pharmacies across Canada, your Sun Life Pay-Direct Drug Card can be used for your prescription drug claims covered by your plan.
The Sun Life Pay-Direct program connects you to a network that tracks your drug purchases, allowing your pharmacist to warn you about duplicate medications, early refills and potential drug interactions.
If you need an additional Sun Life Pay-Direct Drug Card (e.g. for a dependent child or student) or misplace your own card, you can download and print a replacement (paper) Pay-Direct drug card from the password-protected Sun Life Member Services Website. Paper cards are accepted at all pharmacies.
If you have any trouble using your card, please contact the Sun Life Customer Care Centre between 7:00 am and 8:00 pm (EST), Monday to Friday at 1 (800) 361-6212.