Eligible medications
Coverage for drugs listed under the plan formulary, subject to the contract and applicable public-plan coordination.
Employee health benefits
Prescription Drug Benefits for Canadian Employees
Prescription drug coverage can help employees manage everyday medication costs while protecting them from some higher-cost treatments. The value of a plan depends on more than its reimbursement percentage.
Talk to a benefits advisorA Canadian group drug plan can reimburse eligible prescription medications that are not fully covered by a provincial or territorial program. Coverage varies by insurer, contract and employee location, so a medication being prescribed does not automatically mean it is covered.
A well-designed plan balances useful everyday coverage with protection against larger claims. It should also be understandable to employees and financially sustainable for the organization.
Understanding the benefit
What prescription drug coverage may include
Depending on the contract, an employee drug plan may include the following features:
Drug plan controls
Generic substitution, dispensing-fee limits, deductibles or prior authorization can affect what the plan pays.
High-cost protection
Specialty-drug processes and pooling arrangements may help manage risk, but the exact employee coverage still comes from the policy terms.
Plan design
What employers should compare
Two plans with the same reimbursement percentage can produce very different outcomes. Review the formulary, eligible amount, annual or lifetime limits, deductibles, dispensing-fee rules and specialty-drug process. Provincial programs and Quebec requirements may also affect plan design.
Three questions to ask
- 1 Does the formulary fit the needs of the workforce without leaving significant gaps?
- 2 How are specialty drugs, prior authorization and public-plan coordination handled?
- 3 What cost controls support long-term affordability without creating avoidable employee confusion?
Explore related employee benefits
Build the right plan
Turn benefit options into a workable plan.
A NextGen advisor can help you compare coverage, understand the trade-offs and build a sustainable benefits program for your organization.
Talk to an advisor