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Prescription Drug

 Attention Out of Country and Out of Province Students!

Starting January 1, 2018, the Ontario government introduced a new program called OHIP+.  This program allows individual’s under 25 years old, covered under the Ontario Health Insurance Plan (OHIP) to receive free prescription medications for more than 4,400 drug products.  If you do not have OHIP, you must contact your benefit plan coordinator to indicate your home province or country.  If you visit a pharmacist before updating your home province/country your drug claims will be denied.     
   
Your drug plan covers 90% of the cost of most medications legally requiring a prescription to a maximum of $5,000 per benefit year.

Vaccinations are covered at 80% based on reasonable and customary charges. Administration costs associated with providing the injection are not covered. Vaccination benefits are paid through your medical supply benefit and therefore must be submitted via the health claim form. Vaccination claims cannot be submitted using the myBenefits Card.

The maximum amount allowed for a dispensing fee is $8.00. Any amount charged over and above will be payable by the student.

The maximum amount payable to an eligible brand name drug will be limited to the lowest priced item in the appropriate generic category.

The following drugs are covered if they are listed in the Ontario Provincial Formulary and Interchangeable List in effect on the date of purchase:

(a) drugs which require the written prescription of a physician or dentist
(b) injectable drugs including allergy serums and insulin
(c) extemporaneous preparations or compounds if one of the ingredients is a covered drug
(d) certain other drugs that do not require a prescription by law may be covered when prescribed by your physician or dentist. If you have any questions, contact your plan administrator before incurring the expense
(e) hepatitis B vaccine, subject to a maximum of $100 per insured, per benefit year
(f) Nuva Ring (contraceptive), subject to a maximum of $178 per insured, per benefit year
(g) oral contraceptives and the patch (birth control)
(h) all acne preparations excluding Accutane or other acne preparations containing the same medicinal ingredient as Accutane

The following diabetic supplies are covered to a maximum of $200 per benefit year:
(a) insulin syringes
(b) disposable needles for use with non-disposable insulin injection devices
(c) lancets and test strips

IMPORTANT! Advise your doctor and pharmacist that you are on the ON Provincial Formulary.

The ON Provincial Formulary is a specific list of drugs that are eligible for reimbursement under your drug benefit. Formularies are developed to ensure that prescription drugs are available on a cost-effective basis. It covers approximately 85% of the most frequently prescribed drugs. Formularies are reviewed regularly and as a result, updates are made on an ongoing basis.

Exception Process: In the event that the drugs covered by the Formulary are not effective in treating the condition, an exception process is in place. To be eligible for an exception, you must have tried one alternative drug listed on the Formulary. An exception drug request form is available below or from your Benefits Plan Office and must be completed by your physician. Completed forms may be returned to the Student Benefits Plan Office or can be faxed directly to the insurance company.

Request for Coverage of Exception Status Drug form

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