Common use of Prescription Drug Program Clause in Contracts

Prescription Drug Program. The Supplementary Health Plan will cover a prescription drug program, providing ninety (90%) percent coverage including a maximum limit of seven dollars and fifty cents ($7.50) for dispensing fees. The employee will be responsible for payment of all dispensing fees incurred over the seven dollar and fifty cent ($7.50) limit. This prescription drug program will cover cost of “generic equivalent” drugs which are prescribed by a legally licensed medical practitioner or chiropractor, and will cover drugs which require a legal prescription only as defined by the Ontario College of Pharmacy. Coverage for brand-name drugs will only be permitted with a doctor’s prescription that must state “no-substitutes”. No drugs which are deemed “over the counter” will be covered by this plan regardless of whether or not they are prescribed. Effective September 1, 2002, a pay direct prescription drug card will be issued to all eligible employees to be utilized at pharmacies who honour this card system. The employee or eligible dependent will be required to pay 10% of the cost of each prescription and any dispensing fee exceeding $7.50. In instances where the prescription drug card system cannot be utilized, the claim may be submitted to the insurance carrier on the prescribed form for reimbursement of 90% of the total cost, including the limit on the dispensing fee of $7.50. Coordination of benefits will apply to both the prescription drug card and the reimbursement system. Claims will be submitted to the insurance carrier on the forms prescribed for reimbursement.