Prescription Benefit Plan
Prescription drug benefits, up to the amount shown in the Schedule of Benefits, that:
a) are prescribed by a legally qualified medical practitioner or dental practitioner as permitted by law;
and
b) legally requires a prescription and has a Drug Identification Number (DIN);
or
c) are paid on a Pay Direct basis.
If approved by GreenShield, this plan includes drugs with a Drug Identification Number (DIN) that do not legally require a prescription, including insulin and all other approved injectables, as well as related supplies such as diabetic syringes, needles and testing agents.
Certain drugs may require prior approval. Your Pharmacist is aware of the drugs that fall into this category.
In no event will the amount
dispensed exceed a three-month
supply (six months if a vacation
supply is required) of a prescription
at any one time and not more
than a 13-month supply in any 12
consecutive months.
Sherwin-Williams Drug program is based on a Tiered Formulary. See page 10 of the GSC booklet for details.
NOTE:
Drug Benefit over age 65: The Drug Benefit co-pay and the deductible (where applicable) in your province of residence is an eligible benefit.
Quebec residents only: Legislation requires GreenShield to follow the RAMQ (The Regie de l’assurance maladie du Quebec) reimbursement guidelines for all residents of Quebec. If you are younger than age 65, you must enroll for the GreenShield Prescription Drugs benefit plan and GreenShield will be the only payer. If you are age 65 or older, enrollment in RAMQ is automatic, enrollment in the GreenShield Prescription Drugs benefit plan is optional, and RAMQ would be first payer.
If any provisions of this plan do not meet the minimum requirements of the RAMQ plan, adjustments are automatically made to meet RAMQ requirements.
Eligible benefits do not include and no amount will be paid for:
a) Smoking cessation products and
drugs for the treatment of erectile
dysfunction;
b) Products which may lawfully be
sold or offered for sale other than
through retail pharmacies, and which
are not normally considered by
practitioners as medicines for which a
prescription is necessary or required,
c) Ingredients or products which have
not been approved by Health Canada
for the treatment of a medical
condition or disease and are deemed
to be experimental in nature and/or
may be in the testing stage;
d) Mixtures, compounded by a
pharmacist, that do not conform to
GreenShield’s current Compound
Policy.
GreenShield Canada’s (GSC) Tiered Formulary
Tiered formularies are starting to attract attention in the Canadian marketplace. Commonly available in the U.S., and in keeping with our North American benefits approach, tiered formularies group drugs into several categories and assign corresponding reimbursement levels (co-pay or co-insurance) resulting in improved drug plan management.
What is a tiered formulary?
Let’s start by defining a formulary. Simply put, it is a list of drugs that are covered as benefits, in this case, under your GSC drug plan. The plan formulary groups drugs into three tiers, or categories, and assigns a different covered percentage to each tier. This means that you could pay less in out-of-pocket expenses depending on the drug you choose with your doctor. If you choose a drug from tier 1 instead of tier 2, both you and Sherwin-Williams save money.
How it works…
Your plan has been designed to give you maximum flexibility and choice. Most therapeutic drug classes (the group of drugs that treat the same medical condition) have different drugs in different tiers, For example, you will not find all anti-depressants put together in the same tier — each individual anti-depressant is placed into a tier according to cost and efficacy.
See your Plan Overview for details
Need assistance? Contact one of our Benefits Centre Administrators to assist you with your needs
Sherwin-Williams Canada Benefit Service Centre
30 Kelfield Street
Toronto, ON M9W 5A2
Phone: 1-844-994-9989
Email: sherwin@benefitscentre.ca