Changes to Extended Health Benefits
In light of the new managed drug formulary (BlueRX) which took effect on January 1, 2020, this is a brief reminder and summary of the more detailed email recently sent out by the University’s Benefits Office, which explains how the formulary works.
A formulary is a list of covered drugs. It is called a ‘managed’ formulary because it is a list of drugs that have been reviewed to ensure they are both clinically effective and cost-effective before they are added to the plan. Moving to the new formulary will help keep benefits affordable by managing the rising costs of drugs without compromising health outcomes. BlueRX covers brand-name and generic prescription drugs used to treat all major diseases and conditions. For some conditions where multiple effective drugs are available, the plan covers the drugs offering the most affordable treatment.
As of January 1, 2020, acupuncture coverage has been extended to cover acupuncture performed by several types of practitioners, not solely physicians. You can now receive covered acupuncture from a Physician, Physiotherapist, Registered Acupuncturist or Naturopath licensed to perform acupuncture in British Columbia. The maximum benefit payable in any calendar year remains at $200 per person.
Drugs that Require Prior Approval
Certain drugs now require prior approval from Pacific Blue Cross (PBC) or BC PharmaCare before they are eligible for coverage. This is to ensure that less expensive first-line or alternative therapies have been considered, and that the patient has the right condition for the drug. Any plan member or dependent currently prescribed a drug on the list will be grandparented to ensure that there is no disruption in therapy. Pacific Blue Cross has sent a letter to all members who are being grandparented to inform them that the new formulary will not impact their current coverage for a particular drug.
Average Markup and Dispensing Fees
The BlueRX plan has a dispensing fee maximum matching that of BC Pharmacare, currently $10, which is in the range of the fees charged by pharmacies in the PBC Preferred Pharmacy Network (PPN). The plan also covers a drug mark-up of up to 15%. Over the past few years, most pharmacies have come in line with the dispensing fee limit, now charging fees in the range of $10 – $11. However, we still see a large discrepancy in the mark-up pharmacies charge on drugs. Under BlueRX, if you purchase a drug with a mark-up of more than 15%, you will be required to pay the difference.
Average Mark-up and Dispensing Fee by Pharmacy Chain:
|Pharmacy Chain||Markup||Dispensing Fee|
|Shoppers Drug Mart||20%||$10.74|
|All Other Stores||24%||$10.65|
|Peoples Drug Mart||41%||$10.25|
Preferred Pharmacy Network (PPN)
The discrepancy in mark-up is one of the reasons why Pacific Blue Cross promotes its Preferred Pharmacy Network (PPN), as these pharmacies are known to have a lower mark-up on their drugs. The PPN is a useful tool, but excludes many pharmacies in Victoria. Members who want to use a pharmacy more convenient to them should ask that pharmacy about its fees and mark-ups.
Keeping Drug Costs Lower
There are a few other ways that Pacific Blue Cross can help reduce your drug costs. Pharmacy Compass is a free interactive tool developed by Pacific Blue Cross that can help you find better value for medications by comparing the prices at some different pharmacy locations across British Columbia.
In addition, under the Pacific Blue Cross Enhanced Pharmacy Agreement, PBC has an agreement with the BC Pharmacy Association that applies to all pharmacies in BC. This agreement allows them to provide direct billing to Members who are on a PBC plan, provided that the pharmacy signs a contract where it must agree to comply with PBC pricing standards on mark-ups and billing practices, including maximums for high-cost drug claims. Local pharmacies that don’t sign on with PBC have the flexibility to mark up as they see fit. If you want to use a pharmacy that charges more than PBC will cover, you will need to pay up front, and submit your receipt online.
Blue RX Formulary:
Drugs that Require Prior Approval:
Pacific Blue Cross Member log-in:
Benefits Handbook for Faculty & Librarians: