Canadian politicians love to talk about creating a universal pharmacare program. Since this program does not yet exist in Canada, I thought I would share how you can get the most benefit out of your current drug insurance.
You could be missing out on having your medications, both prescription and over-the-counter, covered by your drug insurance. Today, I will walk you through the process to determine if your medications are paid for by your drug insurance using Sun Life Financial’s online portal. Before using your insurance provider’s search tool, I recommend you carefully read through your drug insurance benefit booklet provided by your employer. This document will provide the details as to which drugs are included or excluded from your insurance plan. For example, some plans cover a range of over-the-counter medications for specific health conditions.
Identify your medication
The first step is to identify the specific name and unique identification number of your medication product. I typically recommend that you locate the Drug Identification Number, which you’ll see abbreviated on medication labels as “DIN”. The DIN is the unique 8 digit number assigned by Health Canada to a particular drug product. Some drugs are not actually licensed as drugs, rather they are natural products, and will have a Natural Product Number (NPN). The NPN only means the product is licensed with Health Canada but does nothing to ensure the product is safe or effective, or if it even contains any substance whatsoever (e.g., homeopathic medicines). You may need to use the NPN in the insurer’s search tool, in place of the DIN.
Once you have identified the DIN, you’ll also need to identify the trade (brand) name of the product. This is the main product name on a package and often is indicated by a trademark. For this example, my medication product trade name is “YF-Vax” with the DIN 00428833. The active (generic) name of the medication is the “yellow fever vaccine”.
Log-on to your insurance provider’s online portal
For our example I’ve signed into the Sun Life Financial customer portal. You’ll need to contact your particular insurance company for information on how to register for the portal, if you have not already done so. Typically you’ll be greeted by a home page. Click on take me to…. drug coverage.
Next click on “drug look up” which will take you to a search tool.
Search for your specific medication
If you would like to start a specific medication, or are considering the best option for a particular health condition, this is where you can search in advance to see if a medication is covered. You’ll need to have the DIN and medication product name available. Both can be obtained from your pharmacist or online using the Health Canada Drug Product Database.
In this example you would type 00428833 in the search box and find the yellow fever vaccine.
When I click on the link to the yellow fever vaccine I’m brought to a page that shows I receive 100% drug coverage. In this case there are no alternatives to this medication.
This is great news since now I know that if I require the yellow fever vaccine, the drug is completely covered!
There are situations when your online portal doesn’t give you enough information about a medication. This is when you need to call your drug coverage provider, with the DIN and product name available, and ask them if the drug is covered. They can provide further details and any additional information about additional drug coverage criteria that may need to be met.
If your medication is not covered by your drug insurance, the next step is to submit the expense to your health spending account, if available.
Most of us have drug insurance as a benefit either through our employer or through a public insurance program. By learning which drugs are covered in advance of filling a prescription, you’ll ensure you minimize your out-of-pocket expenses on your medications, saving you both stress and money!