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Products > Group Benefits > Health & Dental > Drug coverage

Drug Benefits

Drug benefits are an important feature of a comprehensive Group Benefits program. Drugs represent approximately 70% of health care expenses and so effective claims management, controls, and innovative plan designs are the keys to selecting the right drug plan.

Payment options

Manulife offers 3 different models for member reimbursement:

 Pay-direct

A plan member can simply present his or her drug card and a valid prescription at virtually any pharmacy in Canada. After entering card and prescription information, the claim is submitted electronically for adjudication. The claim is processed within seconds of the claim being submitted. The pharmacist is then able to confirm whether the drug is covered under the plan, requires prior authorization, and the amount allowed. The plan member only has to pay the balance not covered by the plan.

Provided in partnership with ESI Canada, a pay-direct drug plan offers many additional features that help control costs, manage claims, and support employee health.

 Deferred payment

Seen as a cost control measure, deferred payment acts like pay-direct. The member presents his or her drug card to the pharmacist and the claim is adjudicated electronically. Similar to pay-direct, the pharmacy will know within seconds if the drug is eligible or not and the amount the member is eligible for. The pharmacist is notified to collect 100% of the prescription cost and the member is reimbursed directly by cheque or direct deposit.

All adjudication is supported through our partnership with ESI Canada, and deferred payment has all of the same claims management controls that are available for pay-direct.

Learn More about ESI Canada  

 

Mandatory Generic Subsitution -- Plan Sponsor brochure
Step Therapy -- Plan Sponsor brochure
Understanding limits on pharmacy mark-ups and dispensing fees for Quebec Members
The impact of specialty drugs on the pharmacy benefits landscape
A balanced approach to manage rising costs of pharmacy benefit plans