Frequently Asked Questions

  • How do I find out what drug insurance coverage I have?

    Go to the Guide To Drug Coverage button on the sidebar and pick a province. The Guide will help you identify what plans/programs you may be eligible for.

  • Can I be covered by more than one drug benefit plan?

    Yes you can. Examples are: A family with two working parents who both have family drug benefits through their employers A retired person who is covered by their provincial drug benefit plan and has private insurance/ third part insurance through their employee pension benefits

  • Can I choose not to use my private insurance coverage and apply to my province for coverage?

    Some provincial/territorial plans and federal programs require that you use your private insurance first. Check the specific plans/programs requirements (all plans/programs are on the sidebar). You should also check with your provincial/territorial drug program to see which plans allow you to apply your out-of-pocket cost to the deductible of a provincial plan you may be eligible for. See the Guide to Drug Coverage for your province and also check the individual programs (on the sidebar).

  • What do I do if my insurance company does not cover my drug?

    Call the Benefits department of the insurance company (have your benefits policy number, employer's name and the drug identification number DIN of the medicine you have been prescribed with you) to make sure they are not covering the medication. Ask for the reason they won't cover it. Let the Human Resources manager at your employer know what the insurance company told you and tell her/him your physician wants you to receive this medication and has prescribed it for you. Have her/him contact the insurance company. If your employer has purchased a drug plan for employees that doesn't cover your prescribed medication, they have the option of making an exception for this medication in this instance. Go to the Rejected Claims button on the sidebar for more suggestions

  • How do I find out the drug identification number (DIN) of the medication I have been prescribed?

    Go to the DIN / Product Search button on the sidebar. This will take you to a search page. Click the DIN button and type in the product name.

  • What if my insurance company doesn't cover the full cost of my drug?

    The portion that you have to pay may be applied to a second drug plan, if you have access to another plan (spousal drug coverage, provincial/territorial drug benefit program for example). Some provinces have provincial drug programs, that you may be eligible for, to which you can apply your out-of-pocket costs. Check the Guide to Drug Coverage for your province to review the programs.

  • What is Special Authorization?

    Special authorization is a process where a drug plan or drug benefit program makes a prescriber request coverage for a specific drug (request can be a letter or form detailing the patient's condition, providing specific clinical information and reasons why the medication is necessary) before approval can be granted for reimbursement of the cost of the medication. In some cases there are specific criteria associated with the use of a drug that must be met before approval is granted.

  • What do I do if my special authorization claim is denied?

    Go to the Rejected Claims button on the sidebar for some suggestions.