Pay-Direct Drug Card
The pay-direct drug card is a great feature that is included in your benefit plan. With the drug card, you no longer have to complete a claim form or wait for reimbursement. Simply present the card to your pharmacist and they will send your drug claim electronically to Sun Life Financial. If the drug cost is higher than the amount eligible under your plan, you will simply pay the balance to the pharmacy at the point of sale.
Using your drug card
- Show your card at the pharmacy when you drop off your prescription.
- Advise the pharmacy of your new drug card and have them update their files for you and your dependents.
- Most pharmacies across Canada will accept your drug card. If they don’t, you’ll need to pay for the prescription and submit a claim to Sun Life Financial.
Note: Diabetic supplies cannot be reimbursed through the Pay-Direct drug card, and claims must be submitted through the either the mobile app (using the image upload feature) or by paper.
Avoid any out-of-pocket expenses
To avoid any out-of-pocket expenses, we recommend you always use your Pay-Direct drug card.
It is important to use this drug card every time you get a prescription filled, as this will impact what is charged to Sun Life and what you may have to pay out-of-pocket if you choose not to use the drug card. When you receive your drug card, have your pharmacy update their files for you and your dependents.
When filling a prescription, the pharmacy charge consists of two pieces: the drug ingredient cost, which is the price charged by the manufacturer for the drug and the pharmacy’s dispensing fee, which is the fee a pharmacist charges to fill a prescription.
- If a pharmacy has a mark-up on the drug cost and submits a drug claim where the price is higher than the drug ingredient cost (set limit), Sun Life only pays the pharmacy up to the set limit. Under the terms of the agreement with the drug benefit solutions system Sun Life uses, the pharmacy is not allowed to pass on extra costs for the drug ingredient to you if you use the drug card.
- If a pharmacy’s dispensing fee is higher than the fee limit, the pharmacy may pass on extra costs to you. In Saskatchewan, the current dispensing fee limit is $11.40 (as of September 2015 and fee is subject to change). If you are unsure what the dispensing fee is at the pharmacy you use, ask your pharmacist.
If you choose not to use your drug card at the pharmacy, when you submit your claim for reimbursement you will be required to pay the mark-up cost over the set limit. Because the dispensing fee is not indicated on drug receipts, the claims system uses a pre-calculated average as the limit, which is under the current dispensing fee limit noted above. This may result in the claim not being reimbursed in full.
Getting your card
Sun Life will mail your card to your home address. If you have recently moved, update your address in MyProfile.usask.ca.
Your drug card can also be accessed through Sun Life’s mobile app. Download the app on your smart phone and log in using your access ID and password. On the app, you can view your coverage and recent claims, submit a claim and access your drug card.
Replacing Pay-Direct drug card
If you have lost or misplaced your Pay-Direct drug card, please contact Sun Life to request a new one. You will need to provide your policy number (150798), as well as your member ID (same as your employee ID found on your pay statements).
You can also print a temporary drug card from your Sun Life account online. Go to www.mysunlife.ca to log in to your account. Click on “my coverage,” and on the right-hand side of the screen you will see a link to “print drug card.” You can use this while waiting for your drug card to arrive from Sun Life.
Mandatory Generic Substitution
Mandatory generic substitution helps manage the rising costs associated with prescription drugs, ensuring your plan remains sustainable for the future. Taking generic medication when available enables you to maximize your available benefit dollars.
Mandatory generic substitution helps manage benefit plan costs by reimbursing the cost of your prescription drug up to the lowest priced (usually generic) equivalent. This substitution will occur even if your physician indicates “no substitution” on your prescription. You still have the option to purchase the brand-name drug, but your reimbursement will be based on the lowest-price equivalent.
In other words, if you choose to purchase a brand-named drug rather than an available generic equivalent, you will be responsible for paying the difference between the brand-named and generic drug. If there is no generic equivalent, the plan will reimburse the brand-named drug.
Unable to take generic drug
There may be valid medical reasons for not substituting your brand-name drug with the lowest priced equivalent. If so, you and your doctor will need to complete a drug exception application form. If approved by Sun Life, the plan will cover the cost of the drug up to the maximum allowable amount under the plan. Please contact ConnectionPoint to request this form.
About generic drugs
Both Brand name drugs and generic drugs:
- include the same medication and have the same active ingredients
- have the same clinical standards. In Canada, generic drugs are strictly regulated and must meet specific clinical standards.
- have the same therapeutic qualities, but may just look different in terms of shape or colour. This does not impact their effectiveness.
- differ only in terms of their inactive ingredients – components like binders, fillers and dyes that do not influence their effectiveness.
Prescriptions for Extended Travel
To avoid additional costs when filling prescriptions before leaving province for more than three months make sure you set up a drug prescription extension.
Sun Life Customer Call Centre
Sun Life has a Customer Call Centre that provides information directly related to your benefits, claims submitted and status of your claim. Other questions or scenarios that Sun Life can assist with are:
- How do I update or change my dependents?
- My child is attending University. How do keep them on my plan as an overage dependent?
- What is the status of my claim?
- What is my maximum for a specific service? How do I know if I have reached my benefit maximum?
- What am I or my dependents covered for under a certain plan?
- I am locked out of MySunLife account. How do I reset my password?
- Why was my claim denied?
1-800-361-6212 during the work week from 8am to 8 pm EST.
Or connect online through your MySunLife account. Visit www.mysunlife.ca and enter your access ID and password.