OUR OFFER

Main benefits

• Allows the implementation of all our cost control solutions.
• No form to be completed (except for drugs requiring a prior authorization).

Our drug cards allow a direct or deferred processing of claims at the point-of-sale and give access to a sophisticated claim adjudication system from our partner, Express Scripts Canada.

Main benefits

• Reduces the risk of adverse drug interactions for plan members.
• Prevents plan expenses by limiting duplicate therapies and early renewals.

Each time a plan member has a prescription filled, anywhere in Canada, Express Scripts Canada’s adjudication system analyses it to identify potential drug therapy problems. If any, the system immediately notifies the pharmacist, who can then discuss the issue with the plan member or attending physician.

Main benefit

• Controls plan costs by limiting pharmacists’ mark-up and dispensing fees.

This measure ensures that submitted costs for eligible drugs remain reasonable and ensures a fair sharing of expenses between the member and the plan. The limitations applied reflect the trend in prices observed in each province.

Main benefits

• Ensures that your plan is not the first payer for drugs covered under another private or public plan.
• No administrative processing required for a member with multiple coverage.

Direct coordination of benefits helps plan members covered under two plans to maximize both insurance policies. The coordination is processed automatically at the point-of-sale. A pay-direct drug card is required.

Main benefit

• Optimizes supply duration.

Management of dynamic maintenance drugs allows any drug to be considered as a maintenance drug if it is taken regularly over a specific period of time. Therefore, this helps limit the frequency at which a drug is purchased and reduces wasted expense on extra dispensing fees.

Main benefit

• Ensures that drugs administered at the hospital are not reimbursed by private plans.

Drugs administered in a hospital or external clinic require specific care and most are covered under provincial healthcare plans. The list of drugs included in this program is managed on a monthly basis by the Express Scripts Canada clinical team.

Main benefit

• Generates immediate savings for members and their plan (reduced drug price automatically applied at the pharmacy).

These agreements grant access to certain drugs at a preferred rate negotiated by our partner, Express Scripts Canada. Based on the agreed-upon terms and conditions, plan members benefit from a discount for each drug included in the program. This solution is not available in Quebec.

Main benefit

• Ensures smart use of complex or expensive drug therapies.

Prior authorization is a very effective method to manage the costs of complex or expensive drugs. The reimbursement of certain drugs is approved only when optimal criteria for coverage are met. This ensures that the plan pays only for the most appropriate and cost-effective treatment.

To review our list of drugs requiring prior authorization, click here.

Main benefit

• Helps understand the risk covered and anticipate market trends.

Our drug evaluation process allows us to quickly identify new drugs on the market that could potentially compromise the viability of group plans. A team of highly qualified professionals evaluates the financial risk associated with such drugs and establishes optimal coverage strategies.

Main benefits

• Prevents plans from reimbursing unjustified expenses.
• Provides an analysis and a fast and efficient intervention from iA Financial Group, when required.

As a member of the Canadian Health Care Anti Fraud Association (CHCAA) and a participant in the Express Scripts Canada special audit program to ensure the integrity and accuracy of health claims, we are continually working at implementing the best possible controls to prevent any unjustified expense.