Prescription Drugs

Prescription drugs are covered under the Supplementary Health Care Plan. Coverage is limited to drugs which are only available by law with the written order (prescription) of a physician or practitioner and dispensed by a licensed pharmacist. Coverage includes the following:

  • 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.
  • 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.
  • Medication and dietary supplements which are available over the counter without a prescription are not covered.

Using Sun Life's drug inquiry tool

Sun Life's drug inquiry tool is currently provided to all plan members to indicate which products are preferred products. Having this information will help you have informed conversations with your treating physician and dispensing pharmacist.

Pay-Direct card

Your Sun Life Pay-Direct drug card can be used at pharmacies across Canada for your prescription drug claims that are 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 6 a.m. and 6 p.m. (MST), Monday to Friday at 1-800-361-6212.

Using your health spending account to cover additional costs

You may be able to use your health spending account (HSA) to pay for eligible drug expenses beyond those covered by the supplementary health care plan. Staff impacted by the drug plan changes may wish to allocate more funds to the HSA account to cover anticipated prescription drug costs. Select an option below to view coverage for Support Staff, Academic Staff and Management and Professional Staff (MAPS).

Temporary removal of drug dispensing fee frequency limit

To mitigate drug shortages due to COVID-19, the Pharmacists’ Association of Alberta has limited refills of prescription medication to a 30-day supply. As a result, pharmacies are charging additional dispensing fees every 30 days rather than the standard 90 days.

The Support Staff Supplementary Health Care Plan covers five dispensing fees per calendar year for each maintenance medication. NASA and the university have agreed to temporarily remove this limit to ensure people get the medication they need without paying additional dispensing fees.

The removal of this limit is applicable to eligible employees and their dependents as defined in the Support Staff Supplementary Health Care Plan. The maximum limit of five dispensing fees per calendar year will be reinstated when the Pharmacists’ Association of Alberta removes the restrictions of the 30-day supply of prescription medicines or on January 1, 2021, whichever is earlier.

Additional coverages:
  • Drugs for the treatment of erectile dysfunction.
  • 100% of eligible drug expenses subject to the plan provisions outlined below.
Prior authorization for biologic and specialty drugs
  • Reimbursements for biologic and specialty drugs will be subject to the Sun Life Prior Authorization program. The program covers a number of health conditions as referenced on the Sun Life Prior Authorization website.
  • Changes to drug treatment protocols will be subject to the Prior Authorization program and require prior authorization.
Dispensing fees and dispensing fee frequency limit (DFFL)
  • A one-month supply of prescription drug purchases may be dispensed at one time.
  • Maximum dispensing fee of $8 per prescription. The dispensing fees charged by pharmacies vary among providers. You may wish to look for a pharmacy that is willing to charge only one dispensing fee if you are purchasing a three month supply of a drug, or if they are not in a position to fill the entire requirement of the prescription at once. Should the dispensing fees exceed the maximum allowable you will be responsible to pay the difference directly at the time of purchase. Dispensing fees are an eligible expense for the health spending account.
  • Support staff with prescriptions on the maintenance medications list are covered for all dispensing fees  per certificate for each maintenance medication. Maintenance medications are those used to treat chronic, long-term conditions.
  • If a drug is defined as acute, it will not be part of the DFFL program and all prescription dispensing fees will be covered.
  • If prescribed medications are only dispensed in less than 90/100 day supplies requiring more than five prescriptions per year, members will be required to complete and submit the Sun Life Drug Exemption form for each affected drug.
Mandatory generic substitution or lowest priced equivalent
  • Claims for prescription drugs with a generic substitution, including those where "no-substitution" is identified on the prescription, are reimbursed at the rate of the lowest-priced equivalent.
  • If there is a medically supported reason why an alternative generic drug cannot be used, a member may have their physician complete the Sun Life Drug Exemption form and submit it to Sun Life for review.
  • If a covered member chooses to purchase a brand name drug, the difference between the lowest price generic drug and the brand name will be the member's expense.
Over-the-counter (OTC) medications
  • Reimbursement for over-the-counter drug products will not be permitted under the support staff benefit plan.
  • Life-sustaining OTCs (such as insulin, diabetic supplies, Epi-Pen) and a small number of non-life sustaining OTCs that are injectable OTCs (i.e. injectable vitamins) are included in the plan and will be covered.
  • No grandfathering will apply to this restriction.
Maximum-allowable cost (MAC) or reference based pricing
  • Prescriptions for drugs within the following therapeutic drug classes will be subject to maximum-allowable cost pricing.
  • The support staff drug plan applies a maximum dollar amount to the therapeutic class of drugs (column two) based on the most cost-effective drug within the class (the reference drug) as shown in column four of table one below.
  • Prescriptions for drugs within these classes (column three) are reimbursed at the maximum allowable cost. Members do not have to be prescribed an alternative drug within the MAC program to be reimbursed at the maximum allowable cost.
  • MAC pricing applies to all drug claims in the five therapeutic drug classes listed in table one.
  • Exceptions to the MAC pricing are permitted only if the member can provide a physician's medical evidence that the MAC drug cannot be used. The Sun Life Drug Exemption form must be completed and submitted for review in that case. Members will only be reimbursed for the maximum allowable price of the drugs listed within column four unless an exception is approved.
Support Staff Drugs
Health Condition
Therapeutic Drug Class
Specific Drug (including generics above MAC)
Drugs within MAC

Cholesterol

HMG-CoA reductase inhibitors

Lipitor (Atorvastatin)

Zocor (Simvastatin)

Mevacor (Lovastatin)

Pravachol (Pravastatin)

Lescol (Fluvastatin)

Crestor (Rosuvastatin)

High blood pressure

Angiotensin converting enzyme inhibitors

Mavik (Trandolarpril)

Accupril (Quinapril)

Conversyl (Perindopril)

Monopril (Fosinopril)

Vasotec (Enalpril)

Inhibace (Cilazapril)

Lotensin (Benazepril)

Altace (Ramipril)

Zestril, Prinivil (Lisinopril)

High blood pressure

Angiotensis II receptor blockers

Cozaar (Losartan)

Olmetec (Olemesartan)

Teveten (Eprosartan)

Avapro (Irbesartan)

Edarbi (Azilsartan)

Diovan (Valsartan)

Atacant (Candesartan)

Micardis (Telmisartan)

High blood pressure

Dihydropyridine calcium channel blockers

Plendil, Renedil (Felodipine)

Adalat XL (Nifedipine)

Norvasc (Amlodipine)

Stomach Hyperacidity

Proton pump inhibitors

Pantoloc (Pantaprazole sodium)

Dexilant (Dexlansoprazole)

Prevacid (Lansoprazole)

Losec (Omeprazole)

Tecta (Pantoprazole magnesium)

Pariet (Rabeprazole)

 

 

Additional coverage
  • 100% of eligible expenses on a least-cost alternative.
  • 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.
  • Drugs for the treatment of erectile dysfunction will be limited to a maximum of $1,200 per insured per year.
  • A three-month supply of prescription drug purchases may be dispensed at one time.
Least-cost alternative (LCA)

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 an 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 Supplementary Health Care 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.

Discuss these plan restrictions with your physician prior to obtaining your drug prescription(s) to avoid any misunderstandings.

Additional coverages:
  • 100% of eligible expenses on a least-cost alternative.
  • 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.
  • Drugs for the treatment of erectile dysfunction will be limited to a maximum of $1,200 per insured per year.
  • A three-month supply of prescription drug purchases may be dispensed at one time.
Least-cost alternative (LCA)

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 an 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 Supplementary Health Care 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.

Discuss these plan restrictions with your physician prior to obtaining your drug prescription(s) to avoid any misunderstandings.