Drug coverage
As part of the new EACOM Health Benefits Plan, we’re introducing a new Dynamic Therapeutic Formulary (DTF) that includes a defined list of clinically safe and affordable drugs.
For any Health option you choose (Economy, Select or Premium), drug reimbursement levels will fall under two tiers:
- Preferred drugs – covers the most commonly prescribed drugs, including brand names and generics, which combine best clinical effectiveness with lower price.
- Non-preferred drugs – these are the therapeutic alternatives to preferred drugs that tend to cost more and be less commonly prescribed.
Under the Economy module for Quebec residents, the lower coinsurance will be equal to the RAMQ regulation.
The DTF ensures that the drugs covered in our plan remain affordable and cost-effective. It will also help you make more informed decisions about the drugs you are prescribed.
Here’s how it works
There can be hundreds of drugs on the market that treat a specific medical condition (such as high blood pressure, diabetes, or pain). The DTF looks at the best available medical evidence when creating a list of “preferred drugs” for all medical conditions.
These preferred drugs provide the best healthcare value— that is, the best combination of clinical-effectiveness (how well the drug works) and cost-effectiveness (how much it costs).
Preferred drugs are safe and effective options to treat your medical condition, and will be covered at a higher reimbursement level. Non-preferred drugs will be paid at a lower reimbursement level, which means you may pay a greater portion of the cost if you don’t switch to a preferred drug. Keep in mind, if you’re taking a brand-name drug but there’s a generic version available, it’s mandatory that you select the generic substitution.
How do you know if your drug is a preferred drug covered under the DTF or a non-preferred drug? Your pharmacist can tell you, using your drug card. Or you can use the drug lookup tool on the Manulife mobile app or plan member website.
